Pharyngoesophageal pressure in patients with swallowing disorders

Swallowing and pharyngo-esophageal manometry in obstructive sleep apnea

Introduction

Objective

Methods

Results

Conclusion

Swallowing pressure and pressure profiles in young healthy adults

OBJECTIVES/HYPOTHESIS

To measure the swallowing pressure (SP) of normal subjects using a 2.64-mm-diameter high-resolution manometry (HRM) catheter with 36 circumferential sensors.

STUDY DESIGN

Repeated measures with subjects serving as controls.

METHODS

Thirty healthy subjects swallowed water at different temperatures and volumes to examine the maximum SP at the velopharynx, meso-hypopharynx, upper esophageal sphincter (UES), and cervical esophagus, and the duration of lowered pressure at the UES.

RESULTS

The maximum SP at any location was unaffected by the volume of water, whereas the maximum SP at the UES and cervical esophagus was affected by the temperature. The duration of lowered SP at the UES was significantly prolonged with 10 versus 2 mL of cold water. The pressure curve in males had two peaks (at the velopharynx and UES), whereas that of females had a single peak at the UES.

CONCLUSIONS

Our data obtained with 2.64-mm HRM demonstrated that as the bolus volume is increased, the duration of lowered SP at the UES is prolonged. The higher maximum SP at the velopharynx in males versus females suggests that there may be a gender difference in pressure at the velopharynx that has not been described previously. This implies that it is necessary to take gender differences into consideration when evaluating the etiology of swallowing dysfunction by examining the SP and SP curve. Moreover, the thinner catheter is less invasive and may contribute to obtaining more physiological measurements.

Middle ear of human and pig: a comparison of structures and mechanics

INTRODUCTION

Animal studies are an essential method to evaluate implants for the middle ear prior to clinical studies. New Zealand rabbits, guinea pigs and chinchillas are, among other small mammals, well established animal models, but their auditory system is significantly smaller compared to human. Hence, the suitability of the domestic pig (sus scrofa domesticus) as a new animal model for research on the middle ear (ME), that would match the human in size, was investigated.

METHODS

Thirty halved pig heads were obtained from the butcher and each middle ear was dissected. Using a digital light microscope, several anatomical magnitudes were determined for 24 specimens, namely the planar projected area of the tympanic membrane (TM), in relation to the stapes footplate as well as the dimensions and weight of the ossicles, in order to determine the effective lever ratios. Using normal and micro computed tomography (CT), six porcine temporal bones were scanned and the geometric data obtained were transferred into a finite element model (FEM) simulation of the porcine middle ear. The transfer function was determined and compared to those from humans determined by measurements and simulations, respectively.

RESULTS

The anatomy investigated presented itself as highly comparable to that of the human. Differing from literature, no fourth ossicle could be found. The porcine dimensions and lever ratios determined match the humans far better than those of all established animal models. The obtained transfer function was congruent to the human one. This underlines the suitability of the pig as an animal model for middle ear implants.

Investigation of pharyngeal swallowing function using high-resolution manometry

OBJECTIVES/HYPOTHESIS

This study aimed to demonstrate the feasibility of a novel high-resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.

STUDY DESIGN

Prospective study.

METHODS

Thirty-three asymptomatic adult Japanese controls were studied. A solid-state high-resolution manometry assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 mL of water) pressures at velopharynx, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above-mentioned points of pressure measurement were also measured.

RESULTS

The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point in men were 141.1 +/- 73.5 (mm Hg, mean +/- standard deviation) and 162.7 +/- 94.9, 175.3 +/- 59.7 and 182.9 +/- 83.6, 172.7 +/- 73.8 and 236.1 +/- 78.9, and 10.0 +/- 1.3 (cm) and 10.1 +/- 1.4, 14.1 +/- 1.5 and 14.4 +/- 1.3, 17.9 +/- 1.7 and 18.0 +/- 1.4, respectively. Those in women were 118.9 +/- 38.0 (mm Hg) and 124.7 +/- 43.4, 165.9 +/- 41.5 and 167.3 +/- 65.0, 149.2 +/- 68.7 and 243.7 +/- 87.4, and 9.5 +/- 1.2 (cm) and 9.4 +/- 1.2, 13.0 +/- 1.5 and 12.8 +/- 1.4, 15.8 +/- 1.5 and 16.0 +/- 1.3, respectively. The maximum value of resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure and the distance from the nostril to the mid-point of the width of the resting UES pressure in men and in women were 70.2 +/- 30.0 mm Hg, 4.0 +/- 0.7 cm, 19.1 +/- 1.3 cm, and 61.8 +/- 26.7 mm Hg, 3.6 +/- 0.6 cm, 17.0 +/- 1.2 cm, respectively.

CONCLUSION

The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies.

Pneumatization of the tympanic bulla after blockage of the ventilation route through the eustachian tube in the pig

To examine whether gas exchange occurs in the middle ear air cell system independent of the eustachian tube (ET), we occluded the middle ear clefts of piglets, whose tympanic bullae closely resemble the human mastoid air cell system, and investigated subsequent changes in the air cell system. We anticipated that pneumatization and development of the air cell system would continue if gas were exchanged through the mucosa lining the air cell system. If, on the other hand, mastoid air cells depend on the ET, mastoid development would be impaired or arrested. In noninflamed ears, pneumatization was maintained, and development of the air cell system continued after the middle ear cleft had been occluded with an acrylate adhesive and the bullar air cell system was thus excluded from any communication with the ET. These results indicate that the normal middle ear air cell system has the capacity to perform gas exchange independently of the ET, with gas exchange appearing to occur through the submucosal capillary network.