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Jones CA, Lagus JF, Abdelhalim SM, Osborn CM, Colevas SM, McCulloch TM. Normative High-Resolution Pharyngeal Manometry: Impact of Age, Size of System, and Sex on Primary Metrics and Pressure Stability. Dysphagia 2024; 39:648-665. [PMID: 38231239 DOI: 10.1007/s00455-023-10647-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
There have been many reports of normative pharyngeal swallowing pressures using high-resolution pharyngeal manometry, but there is a fair amount of between-subject variance in reported pressure parameters. The purpose of this study was to put forward normative pharyngeal high-resolution manometry measures across the lifespan and investigate the effects of age, size of system, and sex. High-resolution pharyngeal manometry was performed on 98 healthy adults (43 males) between the ages 21 and 89. Pressure duration, maxima, integral, and within-individual variability metrics were averaged over 10 swallows of 10-ml thin liquid. Multiple linear and logistic regressions with model fitting were used to examine how pharyngeal pressures relate to age, pharyngeal size, and sex. Age was associated with tongue base maximum pressure, tongue base maximum variability, and upper esophageal sphincter-integrated relaxation pressure (F3,92 = 6.69; p < 0.001; adjusted R2 = 0.15). Pharyngeal area during bolus hold was associated with velopharynx integral (F1,89 = 5.362; p = 0.02; adjusted R2 = 0.05), and there was no significant model relating pharyngeal pressures to C2-C4 length (p < 0.05). Sex differences were best described by tongue base integral and hypopharynx maximum variability (χ2 = 10.27; p = 0.006; pseudo R2 = 0.14). Normative data reveal the distribution of swallow pressure metrics which need to be accounted for when addressing dysphagia patients, the importance of pressure interactions in normal swallow, and address the relative stability of swallow metrics with normal aging.
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Affiliation(s)
- Corinne A Jones
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, School of Medicine and Public Health, University of WI - Madison, K4/710 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Jilliane F Lagus
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Suzan M Abdelhalim
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, School of Medicine and Public Health, University of WI - Madison, K4/710 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Caroline M Osborn
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Sophia M Colevas
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, School of Medicine and Public Health, University of WI - Madison, K4/710 CSC, 600 Highland Ave, Madison, WI, 53792, USA
| | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, School of Medicine and Public Health, University of WI - Madison, K4/710 CSC, 600 Highland Ave, Madison, WI, 53792, USA.
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Yang W, Huang Y, He L, Chen D, Wu S, Tian Y, Zheng J, Yang J, Song G. Utilizing Esophageal Motility Tests in Diagnosing and Evaluating Gastroesophageal Reflux Disease. Diagnostics (Basel) 2024; 14:1467. [PMID: 39061603 PMCID: PMC11276196 DOI: 10.3390/diagnostics14141467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Gastroesophageal reflux disease (GERD), a prevalent clinical condition, is often attributed to aberrant esophageal motility, leading to gastric content reflux and associated symptoms or complications. The rising incidence of GERD presents an escalating healthcare challenge. Endoscopic and esophageal reflux monitoring can provide a basis for the diagnosis of patients with gastroesophageal reflux disease, but when the diagnostic basis is at an inconclusive value, some additional supportive evidence will be needed. Advanced technology is the key to improving patient diagnosis, accurate assessment, and the development of effective treatment strategies. High-resolution esophageal manometry (HREM) and endoscopic functional lumen imaging probe (EndoFLIP) represent the forefront of esophageal motility assessment. HREM, an evolution of traditional esophageal manometry, is considered the benchmark for identifying esophageal motility disorders. Its widespread application in esophageal dynamics research highlights its diagnostic significance. Concurrently, EndoFLIP's emerging clinical relevance is evident in diagnosing and guiding the treatment of coexisting esophageal motility issues. This review integrates contemporary research to delineate the contributions of HREM, EndoFLIP, and novel technologies in GERD. It examines their efficacy in facilitating an accurate diagnosis, differentiating similar gastrointestinal disorders, quantifying the extent of reflux, assessing the severity of the disease, forecasting patient responsiveness to proton pump inhibitor therapy, and guiding decisions for surgical interventions. The overarching aim is to deepen the understanding of GERD's underlying mechanisms and advance the formulation of holistic, efficacious treatment approaches.
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Affiliation(s)
- Wangliu Yang
- Department of Gastroenterology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; (W.Y.); (Y.H.); (L.H.); (J.Z.)
| | - Yurong Huang
- Department of Gastroenterology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; (W.Y.); (Y.H.); (L.H.); (J.Z.)
| | - Lei He
- Department of Gastroenterology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; (W.Y.); (Y.H.); (L.H.); (J.Z.)
| | - Dongmei Chen
- Department of Gastroenterology, Liupanshui Municipal People’s Hospital, Liupanshui 553000, China; (D.C.); (S.W.); (Y.T.)
| | - Sheng Wu
- Department of Gastroenterology, Liupanshui Municipal People’s Hospital, Liupanshui 553000, China; (D.C.); (S.W.); (Y.T.)
| | - Yan Tian
- Department of Gastroenterology, Liupanshui Municipal People’s Hospital, Liupanshui 553000, China; (D.C.); (S.W.); (Y.T.)
| | - Juan Zheng
- Department of Gastroenterology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; (W.Y.); (Y.H.); (L.H.); (J.Z.)
| | - Jie Yang
- Department of Gastroenterology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; (W.Y.); (Y.H.); (L.H.); (J.Z.)
| | - Gengqing Song
- Department of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Colevas SM, Stalter LN, Jones CA, McCulloch TM. The Manometric Representation of the Upper Esophageal Sphincter During the Resting State: A Descriptive Study. Dysphagia 2024; 39:348-359. [PMID: 37620520 DOI: 10.1007/s00455-023-10615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
The upper esophageal sphincter (UES) is the high-pressure zone marking the transition between the hypopharynx and esophagus. There is limited research surrounding the resting UES using pharyngeal high-resolution manometry (HRM) and existing normative data varies widely. This study describes the manometric representation of the resting UES using a clinically accessible method of measurement. Data were obtained from 87 subjects in a normative database of pharyngeal HRM with simultaneous videofluoroscopy. The resting UES manometric region was identified and ten measurement segments of this region were taken throughout the duration of the study using the Smart Mouse function within the manometry software. Intraclass correlation coefficients (ICC) were used to analyze within-subject reliability across measurements. Linear mixed-effects regression models were used to analyze how subject characteristics and manometric conditions influence resting UES pressure. There was excellent within-subject reliability between resting UES mean pressures (ICC = 0.96). In bivariate analysis, there were significant effects of age, number of sensors contained within the resting UES, and preceding swallow volume on mean resting UES pressure. For every 1 unit increase in age, there was a 0.19 unit decrease in resting UES pressure (p = 0.008). For every 1 unit increase in number of sensors contained within the resting UES, there was a 3.71 unit increase in resting UES pressure (p < 0.001). This study presents normative data for the resting UES, using a comprehensive and clinically accessible protocol that can provide standard comparison for the study of populations with swallowing disorders, particularly UES dysfunction, and provides support for UES-directed interventions.
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Affiliation(s)
- Sophia M Colevas
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Rm K4/771, Madison, WI, 53792, USA.
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Corinne A Jones
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Neurology (C.A.G.), The University of Texas at Austin, Austin, TX, USA
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI, USA
- The Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy M McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Abnormal Esophageal Clearance Identified During Modified Barium Swallow Study in an Acute Poststroke Cohort. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2643-2662. [PMID: 36179218 DOI: 10.1044/2022_ajslp-22-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Dysphagia impacts many poststroke survivors with wide-ranging prevalence in the acute and chronic phases. One relatively unexplored manifestation of poststroke swallowing impairment is that of primary or co-occurring esophageal dysphagia. The incidence of esophageal dysphagia in this population is unknown despite the shared neuroanatomy and physiology with the oropharynx. We aimed to determine the presence of abnormal esophageal clearance in an acute poststroke sample using the Modified Barium Swallow Impairment Profile (MBSImP) Component 17 (esophageal clearance) as our outcome measure. METHOD We performed a retrospective, cross-sectional, cohort study of 57 poststroke patients with acute, first-ever, ischemic strokes. All participants received a modified barium swallow study (MBSS) using the MBSImP protocol and scoring metrics. Swallowing impairment was determined using a combination of MBSImP scores and Penetration-Aspiration Scale scores. Swallowing outcome measures were collected including Functional Oral Intake Scale and International Dysphagia Diet Standardization Initiative (IDDSI) scores. We performed tests of association and logistic regression analysis to determine if statistically significant associations exist between judgments of esophageal clearance and other swallowing impairments and/or swallowing outcome measures. RESULTS In our study of poststroke patients who received an MBSS as part of their care, 57.9% had abnormal esophageal clearance. Statistically significant associations were also identified in measures of pharyngeal physiology (MBSImP scores) and swallowing outcome measures (IDDSI scores and alternate means of nutrition). CONCLUSIONS Abnormal esophageal clearance was identified in greater than half of our poststroke patients. There is a dearth of scientific research regarding esophageal function poststroke. While esophageal visualization during the MBSS is not diagnostic of esophageal impairment, it may serve as an indicator for those poststroke patients who require dedicated esophageal testing to best determine the full nature of their swallowing pathophysiology and make the most effective treatment recommendations.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation. Auris Nasus Larynx 2022; 49:986-994. [DOI: 10.1016/j.anl.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/17/2022]
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Edeani FO, Kern M, Ulualp K, Kovacic K, Sanvanson P, Mei L, Shaker R. Variables influencing manometric parameters of deglutitive and non-deglutitive upper esophageal sphincter: A study of 89 asymptomatic participants. Neurogastroenterol Motil 2022; 34:e14175. [PMID: 34431179 PMCID: PMC10128622 DOI: 10.1111/nmo.14175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution manometry overcomes limitations imposed by axial and radial asymmetry as well as swallow and respiration-induced movement of the upper esophageal sphincter (UES), allowing for its reliable use in evaluation of dysphagic and reflux patients. The aim of this study was to determine normative values and their variability across position, sex, age, height, weight, BMI, and volume for clinically relevant deglutitive and non-deglutitive UES parameters. METHODS We studied 89 asymptomatic volunteers age 19-90 years, (45 female) during 3-10 repetitions of dry, 5 and 10 ml water swallows at 30-s intervals using high-resolution manometry. KEY RESULTS Upper esophageal sphincter high-pressure zone was longer in men than women and in supine than upright position. UES basal contractile integral and mean basal pressure were higher in supine compared to upright; higher in men than women, inversely correlated with age, correlated positively with height and with weight in the supine position only. UES relaxation duration was longer in upright than in supine position but not affected by age, sex, height, weight, or BMI. It was longer with 5 and 10 ml compared with dry swallows. UES minimum/nadir relaxation and mean relaxation pressures were lower in upright than supine position, increased with increase in age and were higher in men than women. CONCLUSIONS AND INFERENCES Position, sex, age, height, weight, and volume affect some deglutitive and non-deglutitve UES manometric parameters. BMI does not affect the studied manometric parameters. These effects should be taken into consideration in clinical evaluation of UES.
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Affiliation(s)
- Francis O Edeani
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark Kern
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kenan Ulualp
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karlo Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patrick Sanvanson
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ling Mei
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Nollet JL, Cajander P, Ferris LF, Ramjith J, Omari TI, Savilampi J. Pharyngo-Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time. Laryngoscope 2021; 132:1817-1824. [PMID: 34928519 PMCID: PMC9545908 DOI: 10.1002/lary.29987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
Objectives/Hypothesis Modulation of the pharyngeal swallow to bolus volume and viscosity is important for safe swallowing and is commonly studied using high‐resolution pharyngeal manometry (HRPM). Use of unidirectional pressure sensor technology may, however, introduce variability in swallow measures and a fixed bolus administration protocol may induce time and order effects. We aimed to overcome these limitations and to investigate the effect of time by repeating randomized measurements using circumferential pressure sensor technology. Study Design Sub‐set analysis of data from the placebo arm of a randomized, repeated measures trial. Methods HRPM with impedance was recorded using a solid‐state catheter with 36 circumferential pressure sensors and 18 impedance segments straddling from hypopharynx to stomach. Testing included triplicates of 5, 10, and 20 ml thin liquid and 10 ml thick liquid boluses, the order of the thin liquid boluses was randomized. The swallow challenges were repeated approximately 10 minutes after finishing the baseline measurement. Results We included 19 healthy adults (10/9 male/female; age 24.5 ± 4.1 year). Intrabolus pressure, all upper esophageal sphincter (UES) opening and relaxation metrics, and flow timing metrics increased with larger volumes. A thicker viscosity decreased UES relaxation time, UES basal pressure, and flow timing metrics, whereas UES opening extent increased. Pre‐swallow UES basal pressure and post‐swallow UES contractile integral decreased over time. Conclusion Using circumferential pressure sensor technology, the effects of volume and viscosity were largely consistent with previous reports. UES contractile pressures reduced over time. The growing body of literature offers a benchmark for recognizing aberrant pharyngo‐esophageal motor responses. Level of Evidence 3 Laryngoscope, 132:1817–1824, 2022
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Affiliation(s)
- Joeke L Nollet
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Per Cajander
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Lara F Ferris
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jordache Ramjith
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Taher I Omari
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Savilampi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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Ferris L, Doeltgen S, Cock C, Rommel N, Schar M, Carrión S, Scholten I, Omari T. Modulation of pharyngeal swallowing by bolus volume and viscosity. Am J Physiol Gastrointest Liver Physiol 2021; 320:G43-G53. [PMID: 33112160 DOI: 10.1152/ajpgi.00270.2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Oropharyngeal swallowing involves complex neuromodulation to accommodate changing bolus characteristics. The pressure events during deglutitive pharyngeal reconfiguration and bolus flow can be assessed quantitatively using high-resolution pharyngeal manometry with impedance. An 8-French solid-state unidirectional catheter (32 pressure sensors, 16 impedance segments) was used to acquire triplicate swallows of 3 to 20 ml across three viscosity levels using a Standardized Bolus Medium (SBMkit) product (Trisco, Pty. Ltd., Australia). An online platform (https://swallowgateway.com/; Flinders University, South Australia) was used to semiautomate swallow analysis. Fifty healthy adults (29 females, 21 males; mean age 46 yr; age range 19-78 yr old) were studied. Hypopharyngeal intrabolus pressure, upper esophageal sphincter (UES) maximum admittance, UES relaxation pressure, and UES relaxation time revealed the most significant modulation effects to bolus volume and viscosity. Pharyngeal contractility and UES postswallow pressures elevated as bolus volumes increased. Bolus viscosity augmented UES preopening pressure only. We describe the swallow modulatory effects with quantitative methods in line with a core outcome set of metrics and a unified analysis system for broad reference that contributes to diagnostic frameworks for oropharyngeal dysphagia.NEW & NOTEWORTHY The neuromodulation of the healthy oropharyngeal swallow response was described in relation to bolus volume and viscosity challenges, using intraluminal pressure and impedance topography methods. Among a wide range of physiological measures, those indicative of distension pressure, luminal opening, and flow timing were most significantly altered by bolus condition, and therefore can be considered to be potential markers of swallow neuromodulation. The study methods and associated findings inform a diagnostic framework for swallow assessment in patients with oropharyngeal dysphagia.
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Affiliation(s)
- Lara Ferris
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Charles Cock
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Luminal Gastroenterology, Flinders Medical Centre, Adelaide, Australia
| | - Nathalie Rommel
- Department of Neurosciences, Oto-rhino-laryngology Research Group, KU Leuven, Belgium
| | - Mistyka Schar
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Speech Pathology and Audiology, Flinders Medical Centre, Adelaide, Australia
| | - Silvia Carrión
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ingrid Scholten
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Taher Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Rogus-Pulia NM, Jones CA, Forgues AL, Orne J, Macdonald CL, Connor NP, McCulloch TM. Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1550-1562. [PMID: 32569478 PMCID: PMC7893517 DOI: 10.1044/2020_ajslp-19-00134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/02/2019] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Purpose We assessed experienced clinicians' perceptions of benefits and drawbacks to the clinical adoption of pharyngeal high-resolution manometry (HRM). This article focuses on the professional and institutional factors that influence the clinical adoption of pharyngeal HRM by speech-language pathologists (SLPs). Method Two surveys (closed- and open-ended questions) and a series of focus groups were completed with SLP members of both the American Speech-Language-Hearing Association and the Dysphagia Research Society (DRS). Transcripts were inductively coded for emergent themes. Results Thirteen SLPs were recruited to attend focus group sessions at the American Speech-Language-Hearing Association. Eighty-seven SLPs responded to the DRS open-set response survey. Two additional focus groups of 11 SLPs were convened at the DRS meeting. Conventional content analysis revealed overall SLP enthusiasm for the clinical use of HRM, with some concerns about the technology adoption process. The following themes related to the professional and institutional factors influencing clinical adoption were identified: (a) scope of practice, (b) access, (c) clinical workflow, and (d) reimbursement. Conclusion These data serve to elucidate the most salient factors relating to the clinical adoption of pharyngeal HRM into routine speech-language pathology clinical practice. While enthusiasm exists, a variety of systems-level issues must be addressed to support this process.
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Affiliation(s)
- Nicole M. Rogus-Pulia
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
- Department of Medicine, University of Wisconsin–Madison
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Corinne A. Jones
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Department of Neurology, The University of Texas at Austin
| | | | - Jason Orne
- Qualitative Health Research Consultants, LLC, Madison, WI
| | | | - Nadine P. Connor
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
| | - Timothy M. McCulloch
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
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10
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Rosen SP, Jones CA, Hoffman MR, Knigge MA, McCulloch TM. Pressure abnormalities in patients with Zenker's diverticulum using pharyngeal high-resolution manometry. Laryngoscope Investig Otolaryngol 2020; 5:708-717. [PMID: 32864443 PMCID: PMC7444802 DOI: 10.1002/lio2.434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Zenker's diverticulum is associated with reduced cricopharyngeal compliance and abnormal intrabolus pressure. However, it is unclear how the pharynx compensates for these deficits. Developments in manometric technology have improved our ability to capture pharyngeal pressure events. This study aims to describe the pharyngeal-upper esophageal sphincter (UES) pressure profile during swallowing in patients with Zenker's diverticulum. METHODS High-resolution manometry was performed on 11 patients with symptomatic Zenker's diverticulum and 11 age- and sex-matched healthy controls during 10 mL liquid swallowing tasks. Pharyngeal and UES pressure magnitudes, durations, and integrals were compared between patients and controls using independent t tests. Other manometric parameters, including residual UES pressure at the time of maximum tongue base pressure and pharyngeal-UES pressure gradient, were also evaluated. A case example using three-dimensional high-resolution manometry is presented. RESULTS Compared with healthy controls, patients with Zenker's diverticulum exhibited pressure abnormalities in the UES region. While baseline and pre-opening maximum pressures were not different, residual pressures were elevated (P = .001). Pharyngeal-UES pressure gradients did not differ between the two groups. CONCLUSION This study used high-resolution manometry to characterize pharyngeal pressure dynamics in patients with Zenker's diverticulum. The changes occurring at the cricopharyngeus appear to result in persistent UES pressurization during UES opening, rather than high tonic resting pressure. Pharyngeal-UES pressure gradients, critical to bolus passage, were also preserved in this patient population. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Sarah P. Rosen
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corinne A. Jones
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Communication Sciences and DisordersUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Neurology, Dell Medical SchoolThe University of Texas at AustinAustinTexasUSA
| | - Matthew R. Hoffman
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Molly A. Knigge
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Timothy M. McCulloch
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Communication Sciences and DisordersUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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11
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May NH, Davidson KW, Pearson WG, O'Rourke AK. Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave. Head Neck 2019; 42:467-475. [DOI: 10.1002/hed.26029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 11/01/2019] [Accepted: 11/13/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nelson H. May
- Department of Otolaryngology—Head and Neck SurgeryWake Forest School of Medicine Winston‐Salem North Carolina
| | - Kate W. Davidson
- Speech Language Pathologist, Evelyn Trammell Institute for Voice and SwallowingMedical University of South Carolina Charleston South Carolina
| | - William G. Pearson
- Department of Cellular Biology & AnatomyMedical College of Georgia at Augusta University Augusta Georgia
- Department of OtolaryngologyMedical College of Georgia at Augusta University Augusta Georgia
| | - Ashli K. O'Rourke
- Department of Otolaryngology—Head and Neck SurgeryEvelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina Charleston South Carolina
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Chitose S, Shin Y, Sato K, Hamakawa S, Fukahori M, Ono T, Umeno H. Three-dimensional imaging of upper esophageal sphincter resting pressure. Laryngoscope Investig Otolaryngol 2019; 4:645-652. [PMID: 31890883 PMCID: PMC6929582 DOI: 10.1002/lio2.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/18/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE High-resolution manometry (HRM) is used to analyze upper esophageal sphincter (UES) physiology. Conventional HRM can yield imprecise measurements of UES resting pressure given its unidirectional sensors and averaging of circumferential pressure. In contrast, three-dimensional (3D) measurements can yield precise UES resting pressure data over the entire length of the UES. This study conducted a detailed analysis of UES resting pressure as evaluated by 3D-HRM. METHODS Seventeen young, healthy adult participants (7 females and 10 males) were recruited. The 3D-HRM system used includes a pressure sensor catheter (outer diameter, 4 mm) and eight-channel transducers arranged circumferentially to acquire pressure data at 45° intervals. The catheter was inserted transnasally into the esophagus and automatically retracted at a speed of 1 mm/s. Participants performed the following tasks: maintain resting breathing, perform breath holding, and perform the Valsalva maneuver. Data were obtained and compared per millimeter over the longitudinal UES length. RESULTS Clear 3D waveforms were identified, with greater mean UES pressures in anterior-posterior directions than in lateral directions (P < .05). The anterior distribution was located superior to the posterior portion. Significant differences were observed in mean UES pressures and UES resting integrals between resting breathing and the Valsalva maneuver (P < 0.05). No differences in functional UES length were observed. CONCLUSIONS The normal UES resting pressure was not directionally uniform in the luminal structure. 3D-HRM imaging of UES resting pressure can help deepen our understanding of UES physiology. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Shun‐ichi Chitose
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Yasuro Shin
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Kiminori Sato
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Sachiyo Hamakawa
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Mioko Fukahori
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Takeharu Ono
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
| | - Hirohito Umeno
- Department of Otolaryngology—Head and Neck SurgeryKurume University School of MedicineKurumeJapan
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Hamdan AL, Ziade G, Khalifee E, Al Souky N, Jaffal H, El Natout T. Prevalence of MTD among Patients with Functional Dysphagia. OTO Open 2019; 2:2473974X18792469. [PMID: 31535065 PMCID: PMC6738019 DOI: 10.1177/2473974x18792469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/12/2018] [Accepted: 07/13/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To assess the prevalence of laryngeal muscle tension patterns among patients with functional dysphagia. Study Design Retrospective study. Setting The study took place at a university medical center. Material and Methods The medical charts and laryngeal video recordings were reviewed for all patients who presented with dysphagia and who were referred for barium swallow between 2012 and 2017. A total of 170 cases were identified. Only those with normal findings on barium swallow and the absence of vocal fold pathology (exudative lesions, masses or tumors, paresis, and paralysis), referred to as functional dysphagia, were included in this study. Information retrieved included swallowing and phonatory symptoms in addition to patterns of laryngeal muscle tension. Results The mean ± SD age of the total group was 41.90 ± 15.10 years with a male:female ratio of 4:1. Seventy-five percent had evidence of at least 1 type of laryngeal muscle tension pattern. The most common pattern was type III, characterized by supraglottic anteroposterior compression (13 of 20), followed by type II, characterized by medial compression of the false vocal folds (5 of 20); only 1 patient had muscle tension pattern type IV, characterized as sphincter-like closure of supraglottic structures. The most common laryngopharyngeal symptom was throat discomfort when swallowing (35%), followed by throat clearing and choking/coughing when eating and drinking (25%). Conclusion The high prevalence of laryngeal muscle tension pattern among patients with functional dysphagia supports the notion that laryngeal tension may be one of the underlying causes of dysphagia.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Ziade
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Khalifee
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nader Al Souky
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamer El Natout
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Prevalence of Dysphagia in Patients With Non-neoplastic Vocal Fold Pathology. J Voice 2019; 33:708-711. [DOI: 10.1016/j.jvoice.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
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High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics-Recommendations of a High-Resolution Pharyngeal Manometry International Working Group. Dysphagia 2019; 35:281-295. [PMID: 31168756 DOI: 10.1007/s00455-019-10023-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/28/2019] [Accepted: 05/25/2019] [Indexed: 02/08/2023]
Abstract
High-resolution manometry has traditionally been utilized in gastroenterology diagnostic clinical and research applications. Recently, it is also finding new and important applications in speech pathology and laryngology practices. A High-Resolution Pharyngeal Manometry International Working Group was formed as a grass roots effort to establish a consensus on methodology, protocol, and outcome metrics for high-resolution pharyngeal manometry (HRPM) with consideration of impedance as an adjunct modality. The Working Group undertook three tasks (1) survey what experts were currently doing in their clinical and/or research practice; (2) perform a review of the literature underpinning the value of particular HRPM metrics for understanding swallowing physiology and pathophysiology; and (3) establish a core outcomes set of HRPM metrics via a Delphi consensus process. Expert survey results were used to create a recommended HRPM protocol addressing system configuration, catheter insertion, and bolus administration. Ninety two articles were included in the final literature review resulting in categorization of 22 HRPM-impedance metrics into three classes: pharyngeal lumen occlusive pressures, hypopharyngeal intrabolus pressures, and upper esophageal sphincter (UES) function. A stable Delphi consensus was achieved for 8 HRPM-Impedance metrics: pharyngeal contractile integral (CI), velopharyngeal CI, hypopharyngeal CI, hypopharyngeal pressure at nadir impedance, UES integrated relaxation pressure, relaxation time, and maximum admittance. While some important unanswered questions remain, our work represents the first step in standardization of high-resolution pharyngeal manometry acquisition, measurement, and reporting. This could potentially inform future proposals for an HRPM-based classification system specifically for pharyngeal swallowing disorders.
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Cock C, Omari T. Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years). Geriatrics (Basel) 2018; 3:geriatrics3040067. [PMID: 31011102 PMCID: PMC6371098 DOI: 10.3390/geriatrics3040067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/15/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.
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Affiliation(s)
- Charles Cock
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
| | - Taher Omari
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
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Silva RMBD, Herbella FAM, Gualberto D. NORMATIVE VALUES FOR A NEW WATER-PERFUSED HIGH RESOLUTION MANOMETRY SYSTEM. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:30-34. [PMID: 30088532 DOI: 10.1590/s0004-2803.201800000-40] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/03/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Esophageal manometry is the most reliable method to evaluate esophageal motility. High resolution manometry (HRM) provides topographic contour colored plots (Clouse Plots) with simultaneous analysis from the pharynx to the stomach. Both solid state and water-perfused systems are available. OBJECTIVE This study aims to determinate the normative data for a new water-perfused HRM. METHODS HRM was made in 32 healthy volunteers after 8 hours fasting. HRM system used consisted of a 24-channel water-perfused catheter (Multiplex, Alacer Biomedica, São Paulo, Brazil). The reusable catheter is made of polyvinyl chloride (PVC) with 4.7 mm of diameter. Side holes connected to pressure transducers are spaced 2 cm for the analysis from the pharynx to the lower esophageal sphincter (LES). Holes are spaced 5 mm and 120° in a spiral disposition in the LES area. The sensors encompass 34 cm in total. Upper esophageal sphincter (UES) parameters studied were basal and relaxation pressures. Esophageal body parameters were distal contractile integral (DCI), distal latency (DL) and break. LES parameters studied were basal pressure, integrated residual pressure (IRP), total and abdominal length. Variables are expressed as mean ± standard deviation, median (interquartile range) and percentiles 5-95th. RESULTS All volunteers (17 males, aged 22-62 years) completed the study and tolerated the HRM procedure well. Percentiles 5-95th range were calculated: Upper Esophageal Sphincter (UES) basal pressure 16.7-184.37 (mmHg), DL: 6.2-9.1 (s), DCI: 82.72-3836.61 (mmHg.s.cm), break: <7.19 (cm), LES basal pressure: 4.89-37.16 (mmHg), IRP: 0.55-15.45 (mmHg). CONCLUSION The performance and normative values obtained for this low-cost water-perfused HRM seems to be adequate for clinical use.
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Affiliation(s)
| | - Fernando A M Herbella
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cirurgia, São Paulo, SP, Brasil
| | - Daniel Gualberto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cirurgia, São Paulo, SP, Brasil
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Triantafyllou T, Theodoropoulos C, Mantides A, Chrysikos D, Smparounis S, Filis K, Zografos G, Theodorou D. Can the upper esophageal sphincter contractile integral help classify achalasia? Ann Gastroenterol 2018; 31:456-461. [PMID: 29991890 PMCID: PMC6033759 DOI: 10.20524/aog.2018.0270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background: The use of high-resolution manometry (HRM) in achalasia patients has revealed abnormal findings concerning upper esophageal sphincter (UES) function. The introduction of the UES contractile integral (UES-CI), as with the distal contractile integral (DCI), may complement the interpretation of the manometric study of achalasia subtypes, defined by the Chicago Classification v3.0. Methods: Patients were classified into achalasia subtypes based on HRM. UES length (cm), UES resting pressure (mmHg), and UES residual pressure (mmHg) were recorded. UES-CI (mmHg·sec·cm) was calculated in a manner similar to that used for the DCI measurement at rest (landmark CI), corrected for respiration, and its relation to achalasia subtypes was evaluated. Results: Twenty-four achalasia patients with mean age 55.29 years were included. Of these, 16.6% (n=4) were diagnosed with achalasia type I, 58.3% (n=14) with type II, and 25% (n=6) with type III. The landmark UES-CI, mean UES-CI, UES-CI corrected for respiration, and UES resting pressure were found to be significantly higher among patients with achalasia type II compared to the other types (1768.9 vs. 677.1, P=0.03; 1827.1 vs. 3555.1, P=0.036; 174.2 vs. 72.8, P=0.027; and 108.1 vs. 55.8, P=0.009, respectively). Conclusions: We introduce the CI index as a tool for the manometric evaluation of the UES in achalasia. UES resting pressure, landmark UES-CI and mean UES-CI were significantly higher in achalasia patients with panesophageal pressurization compared to types I and III. This finding may reflect a protective reaction against the risk of aspiration in this group, but further studying and clinical correlation is required.
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Affiliation(s)
- Tania Triantafyllou
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | - Charalampos Theodoropoulos
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | | | - Demosthenis Chrysikos
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | - Spyridon Smparounis
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | - Konstantinos Filis
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | - Georgios Zografos
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
| | - Dimitrios Theodorou
- Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou)
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19
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Jones CA, Meisner EL, Broadfoot CK, Rosen SP, Samuelsen CR, McCulloch TM. Methods for measuring swallowing pressure variability using high-resolution manometry. FRONTIERS IN APPLIED MATHEMATICS AND STATISTICS 2018; 4:23. [PMID: 30687729 PMCID: PMC6345545 DOI: 10.3389/fams.2018.00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3 - 10 consecutive swallows had no overall difference in variability, but sets of 2 swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.
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Affiliation(s)
- Corinne A. Jones
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
- Neuroscience Training Program; University of Wisconsin – Madison; Madison, WI, USA
| | - Ellen L. Meisner
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Physical Therapy, Mayo Clinic School of Health Sciences, Rochester, MN, USA
| | - Courtney K. Broadfoot
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
| | - Sarah P. Rosen
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
| | - Christine R. Samuelsen
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
| | - Timothy M. McCulloch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
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Tsujimura T, Suzuki T, Yoshihara M, Sakai S, Koshi N, Ashiga H, Shiraishi N, Tsuji K, Magara J, Inoue M. Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure. J Appl Physiol (1985) 2018; 124:1148-1154. [PMID: 29357492 DOI: 10.1152/japplphysiol.00944.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.
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Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Shogo Sakai
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Naomi Koshi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Hirokazu Ashiga
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.,Department of Rehabilitation, Niigata University of Rehabilitation, Murakami, Niigata , Japan
| | - Naru Shiraishi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Kojun Tsuji
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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Ferris L, Schar M, McCall L, Doeltgen S, Scholten I, Rommel N, Cock C, Omari T. Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter. Laryngoscope 2017; 128:1328-1334. [DOI: 10.1002/lary.26820] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/31/2017] [Accepted: 06/30/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Lara Ferris
- Gastroenterology DepartmentWomen's and Children's HospitalAdelaide Australia
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Mistyka Schar
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Lisa McCall
- Gastroenterology DepartmentWomen's and Children's HospitalAdelaide Australia
| | - Sebastian Doeltgen
- School of Health SciencesDiscipline of Speech Pathology, Flinders UniversityAdelaide Australia
| | - Ingrid Scholten
- School of Health SciencesDiscipline of Speech Pathology, Flinders UniversityAdelaide Australia
| | - Nathalie Rommel
- Neurosciences DepartmentResearch Group Experimental Otorhinolaryngology, University of LeuvenLeuven Belgium
| | - Charles Cock
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Taher Omari
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
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Abstract
OPINION STATEMENT Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.
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Affiliation(s)
- Scott M Smukalla
- Department of Gastroenterology, Center for Esophageal Disease, NYU School of Medicine, 240 East 38th St., 23rd Floor, New York, NY, 10016, USA
| | - Irina Dimitrova
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Abraham Khan
- Department of Gastroenterology, Center for Esophageal Disease, NYU School of Medicine, 240 East 38th St., 23rd Floor, New York, NY, 10016, USA.
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Managing dysphagia in trachesotomized patients: where are we now? Curr Opin Otolaryngol Head Neck Surg 2017; 25:217-222. [DOI: 10.1097/moo.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosen SP, Jones CA, McCulloch TM. Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry. Laryngoscope 2017; 127:1989-1995. [PMID: 28215047 DOI: 10.1002/lary.26483] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This study aims to use three-dimensional (3D) high-resolution manometry to identify circumferential pressure patterns generated within the asymmetrical base-of-tongue and hypopharynx regions of the pharynx during deglutition. STUDY DESIGN Case series. METHODS Radial pressures in the regions of interest were evaluated during swallowing events in 12 healthy subjects using 3D high-resolution manometry. RESULTS Repeated measures analysis of variance revealed asymmetrical pharyngeal clearance pressures in the base-of-tongue and hypopharynx regions during swallowing. A significant main effect of direction on pressure was found at the time point of average maximum pressure (P < 0.001) and for pressure integral (P < 0.001), with pressure primarily generated from the posterior direction. An interaction was noted between direction and location when comparing maximum directional pressures, regardless of time (P =0.045), highlighting the differences in anterior pressure production between regions. In contrast to the high posterior pressures produced in the base-of-tongue region, an anteroposterior dominant pressure pattern was observed in the hypopharynx. Pressure waveform complexity in the hypopharynx also is likely attributed to activity in the anterior and posterior directions. Symmetrical pressure generation was observed during intrabolus flow within the hypopharynx. CONCLUSION This study shows that pressure is asymmetrically generated in the base-of-tongue and hypopharynx regions during swallowing of a 10-mL bolus, reflecting the complex anatomy within the pharynx. Understanding of these complex pressure patterns aids in the interpretation of high-resolution manometry and can help guide further study in the clinical assessment and treatment of pharyngeal pathology. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1989-1995, 2017.
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Affiliation(s)
- Sarah P Rosen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Corinne A Jones
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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