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Miller AL, O'Rourke AK. Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States? Laryngoscope 2024; 134:3698-3705. [PMID: 38727412 DOI: 10.1002/lary.31495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. METHODS We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. RESULTS We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. CONCLUSION Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3698-3705, 2024.
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Affiliation(s)
- Ashley L Miller
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ashli K O'Rourke
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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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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Stewart A, Govender R, Eaton S, Smith CH, De Coppi P, Wray J. The characteristics of eating, drinking and oro-pharyngeal swallowing difficulties associated with repaired oesophageal atresia/tracheo-oesophageal fistula: a systematic review and meta-proportional analysis. Orphanet J Rare Dis 2024; 19:253. [PMID: 38965635 PMCID: PMC11225380 DOI: 10.1186/s13023-024-03259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Eating, drinking and swallowing difficulties are commonly reported morbidities for individuals born with OA/TOF. This study aimed to determine the nature and prevalence of eating, drinking and oro-pharyngeal swallowing difficulties reported in this population. METHOD A systematic review and meta-proportional analysis were conducted (PROSPERO: CRD42020207263). MEDLINE, EMBASE, CINAHL, Pubmed, Scopus, Web of Science databases and grey literature were searched. Quantitative and qualitative data were extracted relating to swallow impairment, use of mealtime adaptations and eating and drinking-related quality of life. Quantitative data were summarised using narrative and meta-proportional analysis methods. Qualitative data were synthesised using a meta-aggregation approach. Where quantitative and qualitative data described the same phenomenon, a convergent segregated approach was used to synthesise data. RESULTS Sixty-five studies were included. Six oro-pharyngeal swallow characteristics were identified, and pooled prevalence calculated: aspiration (24%), laryngeal penetration (6%), oral stage dysfunction (11%), pharyngeal residue (13%), nasal regurgitation (7%), delayed swallow initiation (31%). Four patient-reported eating/drinking difficulties were identified, and pooled prevalence calculated: difficulty swallowing solids (45%), difficulty swallowing liquids (6%), odynophagia (30%), coughing when eating (38%). Three patient-reported mealtime adaptations were identified, and pooled prevalence calculated: need for water when eating (49%), eating slowly (37%), modifying textures (28%). Mixed methods synthesis of psychosocial impacts identified 34% of parents experienced mealtime anxiety and 25% report challenging mealtime behaviours reflected in five qualitative themes: fear and trauma associated with eating and drinking, isolation and a lack of support, being aware and grateful, support to cope and loss. CONCLUSIONS Eating and drinking difficulties are common in adults and children with repaired OA/TOF. Oro-pharyngeal swallowing difficulties may be more prevalent than previously reported. Eating, drinking and swallowing difficulties can impact on psychological well-being and quality of life, for the individual and parents/family members. Long-term, multi-disciplinary follow-up is warranted.
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Affiliation(s)
- Alexandra Stewart
- Department of Language and Cognition, University College London, Chandler House,2 Wakefield Street, London, WC1N 1PF, UK.
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Roganie Govender
- Head and Neck Academic Centre, Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-47 Foley Street, London, W1W 7TS, UK
- University College London Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christina H Smith
- Department of Language and Cognition, University College London, Chandler House,2 Wakefield Street, London, WC1N 1PF, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Saleem S, Miles A, Allen J. Pharyngeal adaptation to bolus properties in patients with Parkinson's disease. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08774-y. [PMID: 38867001 DOI: 10.1007/s00405-024-08774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Dysphagia is common in people with Parkinson's disease (PD). Yet, literature describing swallow function in PD using high-resolution manometry is limited. This study explored swallowing pressure metrics for varied bolus conditions in people with PD. METHOD A solid-state unidirectional catheter was used to acquire manometric data for triplicate swallows (5 ml, 10 ml, 20 ml; IDDSI 0, 2 & 4). Penetration-aspiration severity was rated during videofluoroscopy. Patient-reported measures included PDQ-8: Parkinson's Disease Questionnaire-8 and EAT-10: Eating Assessment Tool-10. Quantitative manometric swallow analysis was completed through Swallow Gateway™. Metrics were compared to published normative values and generalized linear model tests explored modulatory effects. RESULTS 21 participants (76% male; mean age 69.6 years, SD 7.1) with mild-moderate severity PD were studied. Two patients (9%) aspirated for single bolus thin liquid and paste trials and 15 patients (73%) scored > 3 EAT-10. Standardized PDQ-8 scores correlated with EAT-10 (p < 0.05). Abnormality in UES relaxation and distension was demonstrated by high UES integrated relaxation pressure and low UES maximum admittance (UES MaxAdm) values across varied bolus conditions. Participants demonstrated abnormally elevated pharyngeal contractility and increased post-swallow upper-esophageal sphincter (UES) contractility for thinner liquid trials. Alterations in volume and viscosity had significant effects on the bolus timing metric-distention to contraction latency. UES peak pressure measures were altered in relation to bolus viscosity. CONCLUSION This study identifies early pharyngoesophageal contractile changes in relation to bolus volume and viscosity in PD patients, associated with subtle deterioration of self-reported swallow scores. Manometric evaluation may offer insight into PD-related swallowing changes and help optimize diagnostics and treatment planning.
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Affiliation(s)
- Shakeela Saleem
- Speech Science, School of Psychology, The University of Auckland, B072, Level 2, Building 507, Grafton Campus, Park Road, Private Bag 92019, Auckland, New Zealand.
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, B072, Level 2, Building 507, Grafton Campus, Park Road, Private Bag 92019, Auckland, New Zealand
| | - Jacqueline Allen
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Saleem S, Miles A, Allen J. Investigating Parkinson's disease with dual high resolution pharyngeal manometry with impedance and videofluoroscopy. Neurogastroenterol Motil 2024; 36:e14737. [PMID: 38225798 DOI: 10.1111/nmo.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE To characterize pharyngeal function in people with Parkinson's Disease using both high resolution impedance manometry (HRIM) and videofluoroscopy (VFSS) and to explore correlations between VFSS and HRIM metrics. METHODS All participants received both VFSS and HRIM within 24 h-time window. A standard VFSS protocol (IDDSI 0: 1 mL, 3 mL, 20 mL, and 100 mL) was performed. A solid-state unidirectional catheter (36 pressure sensors) was used to acquire manometric data for triplicate swallows (IDDSI 0: 5 mL, 10 mL, 20 mL), quantitative swallow analysis was completed through Swallowtail™ and SwallowGateway™. Parameters were compared to published norms and statistical tests explored correlational associations (p < 0.05). RESULTS Twenty-one participants (76% male; mean age 70 years, SD7.16) with mild-moderate severity PD were recruited with 73% reporting Eating Assessment Tool (EAT-10) scores ≥3 indicating swallow impairment. Compared to normal metrics, one third of participants had abnormally elevated hypopharyngeal contractile integral (HPCI), hypopharyngeal peak pressure, upper esophageal sphincter (UES) integrated relaxation pressure (UES IRP), and reduced UES maximum admittance. Five participants showed compromised swallow safety (Penetration-Aspiration Scale score ≥6). One third of participants had abnormal VFSS values for pharyngoesophageal segment (PES) opening duration, maximum PES opening distance, and maximum hyoid displacement measures. Some HRIM metrics had a strong correlation with pharyngeal VFSS measures (r > 0.60, p < 0.05). CONCLUSION This study identifies early manometric signs of pharyngeal dysfunction in people with PD. The congruence of the VFSS and HRIM measures confirms the hypothesis of insidious early decline in swallow function in PD despite maintenance of airway safety (i.e., low aspiration rates).
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Affiliation(s)
- Shakeela Saleem
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Jacqueline Allen
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Damrongmanee A, El-Chammas K, Santucci N, Fei L, Kaul A. Characterization of pharyngeal contractile integral using pharyngeal manometry in children. J Pediatr Gastroenterol Nutr 2024; 78:783-789. [PMID: 38314945 PMCID: PMC11111290 DOI: 10.1002/jpn3.12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Pharyngeal contractile integral (PhCI) is the product of mean pharyngeal contractile amplitude, length, and duration, and provides a single metric for the vigor of entire pharyngeal contraction. A major limitation in children is lack of characterization of PhCI on high-resolution pharyngeal manometry. We aimed to determine and compare the values of PhCI in children with the abnormal and normal videofluoroscopic study of swallow (VFSS). METHODS Children who underwent high-resolution pharyngeal and esophageal manometry (HRPM/HREM), as well as VFSS, were divided into two groups; "normal VFSS" and "abnormal VFSS" groups. PhCI was calculated from the pharyngo-esophageal manometry analysis software (MMS, v9.5, Laborie Medical Technologies), and compared in these two groups. RESULTS Of 67 children, 9 had abnormal VFSS (mean age 64 ± 50 months; 66.7% males), while 58 had normal VFSS (mean age 123 ± 55 months; 47% males). The mean PhCI in abnormal and normal VFSS groups was 82.00 ± 51.90 and 147.28 ± 53.89 mmHg.s.cm, respectively (p = 0.001). Subjects with abnormal VFSS were significantly younger than those with normal VFSS (p = 0.003). However, after adjusting for the VFSS result, age was no longer related to PhCI (p = 0.364). In subgroup analysis of children presenting with dysphagia, the mean PhCI in abnormal (9 subjects) and normal (36 subjects) VFSS groups was 82.00 ± 51.90 and 141.86 ± 50.39 mmHg.s.cm, respectively (p = 0.003). CONCLUSIONS PhCI was significantly lower in children with abnormal VFSS than in those with normal VFSS. We did not find a significant impact of age on PhCI in our pediatric populations.
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Affiliation(s)
- Alisara Damrongmanee
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Khalil El-Chammas
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Neha Santucci
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lin Fei
- Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Ohio, USA
| | - Ajay Kaul
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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Kapavarapu PK. Characterization of pharyngeal contractile integral using pharyngeal manometry in children. J Pediatr Gastroenterol Nutr 2024; 78:753-754. [PMID: 38323668 DOI: 10.1002/jpn3.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/14/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Prasanna K Kapavarapu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Miyagawa S, Yaguchi H, Kunieda K, Ohno T, Fujishima I. Speech-Swallow Dissociation of Velopharyngeal Incompetence with Pseudobulbar Palsy: Evaluation by High-Resolution Manometry. Dysphagia 2024:10.1007/s00455-024-10687-1. [PMID: 38492048 DOI: 10.1007/s00455-024-10687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Patients with pseudobulbar palsy often present with velopharyngeal incompetence. Velopharyngeal incompetence is usually observed during expiratory activities such as speech and/or blowing during laryngoscopy. These patients typically exhibit good velopharyngeal closure during swallowing, which is dissociated from expiratory activities. We named this phenomenon "speech-swallow dissociation" (SSD). SSD on endoscopic findings can help in diagnosing the underlying disease causing dysphagia. This endoscopic finding is qualitative, and the quantitative characteristics of SSD are still unclear. Accordingly, the current study aimed to quantitatively evaluate SSD in patients with pseudobulbar palsy. We evaluated velopharyngeal pressure during swallowing and expiratory activity in 10 healthy subjects and 10 patients with pseudobulbar palsy using high-resolution manometry, and compared the results between the two groups. No significant differences in maximal velopharyngeal contraction pressure (V-Pmax) were observed during dry swallowing between the pseudobulbar palsy group and healthy subjects (190.5 mmHg vs. 173.6 mmHg; P = 0.583). V-Pmax during speech was significantly decreased in the pseudobulbar palsy group (85.4 mmHg vs. 34.5 mmHg; P < 0.001). The degree of dissociation of speech to swallowing in V-Pmax, when compared across groups, exhibited a larger difference in the pseudobulbar palsy group, at 52% versus 80% (P = 0.001). Velopharyngeal pressure during blowing was similar to that during speech. Velopharyngeal closure in patients with pseudobulbar palsy exhibited weaker pressure during speech and blowing compared with swallowing, quantitatively confirming the presence of SSD. Pseudobulbar palsy often presents with SSD, and this finding may be helpful in differentiating the etiology of dysphagia.
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Affiliation(s)
- Shinji Miyagawa
- Department of Neurology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan.
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan.
| | - Hiroshi Yaguchi
- Department of Neurology, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohisa Ohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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Walters RK, Gudipudi R, Gordis T, Davidson K, Nguyen SA, O'Rourke AK. A Systematic Review of Pharyngeal High-Resolution Manometry Normative Data. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1059-1068. [PMID: 38127890 DOI: 10.1044/2023_ajslp-23-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values. METHOD A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure. RESULTS Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters. CONCLUSIONS Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24843753.
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Affiliation(s)
- Rameen K Walters
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Rachana Gudipudi
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Tamar Gordis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Kate Davidson
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
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Martínez-Guillén M, Clavé P, Zavala M, Carrión S. High-resolution manometry with impedance for the study of pharyngeal motility and the upper esophageal sphincter: Keys for its use in the study of the pathophysiology of oropharyngeal dysphagia. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:272-285. [PMID: 37816469 DOI: 10.1016/j.gastrohep.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
Oropharyngeal dysphagia (OD) is a pathology with a high prevalence in different patient phenotypes. High-resolution pharyngoesophageal manometry (HRPM) with impedance (HRPM-I) has become in recent years a fundamental technique for better understanding the pathophysiology of pharynx and upper oesophageal sphincter (UES) dysfunctions in patients with OD. Various groups of experts have proposed a methodology for the practice of the HRPM-I and for the standardization of the different metrics for the study of pharyngeal motility and UES dysfunctions based on the quantification of 3main phenomena: relaxation of the UES, resistance to flow through the UES and propulsion of the bolo through the pharynx into the oesophagus. According to the alterations of these metrics, 3patterns of dysfunction are proposed that allow a specific therapeutic approach: (a) UES flow restriction with normal pharyngeal propulsión; (b) UES flow restriction with ineffective pharyngeal propulsion, and (c) ineffective pharyngeal contraction with normal relaxation of the UES. We present a practical review of the methodology and metrics used by the main working groups together with the description of the main patterns of dysfunction according to our experience to highlight the usefulness of the HRPM-I in the study of the pathophysiology and selection of a specific treatment in patients with OD.
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Affiliation(s)
| | - Pere Clavé
- Unidad de Pruebas Funcionales Digestivas, Hospital de Mataró, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, España
| | - Mónica Zavala
- Unidad de Pruebas Funcionales Digestivas, Hospital de Mataró, Mataró, Barcelona, España; Universidad La Salle México, Ciudad de México, México
| | - Silvia Carrión
- Unidad de Pruebas Funcionales Digestivas, Hospital de Mataró, Mataró, Barcelona, España; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, España.
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12
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Chen SF, Jia XY, Hou X, Tang MM, Tan ND, Zhang MY, Xiao YL, Wang JH. High-resolution manometry evaluation and endoscopic myotomy for pediatric cricopharyngeal achalasia: A case report and literature review. J Dig Dis 2024; 25:70-74. [PMID: 38375998 DOI: 10.1111/1751-2980.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/11/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Song Feng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xing Yu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xun Hou
- Gastrointestinal Surgery Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Mi Mi Tang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Nian Di Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Meng Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ying Lian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jin Hui Wang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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13
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Nakamori M, Ishikawa R, Watanabe T, Toko M, Naito H, Takahashi T, Simizu Y, Yamazaki Y, Maruyama H. Swallowing sound evaluation using an electronic stethoscope and artificial intelligence analysis for patients with amyotrophic lateral sclerosis. Front Neurol 2023; 14:1212024. [PMID: 37602264 PMCID: PMC10435850 DOI: 10.3389/fneur.2023.1212024] [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: 04/25/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background and purpose Non-invasive, simple, and repetitive swallowing evaluation is required to prevent aspiration pneumonia in neurological care. We investigated the usefulness of swallowing sound evaluation in patients with amyotrophic lateral sclerosis (ALS) using our new electronic stethoscope artificial intelligence (AI) analysis tool. Methods We studied patients with ALS who provided written informed consent. We used an electronic stethoscope, placed a Bluetooth-enabled electronic stethoscope on the upper end of the sternum, performed a 3-mL water swallow three times, and remotely identified the intermittent sound components of the water flow caused at that time by AI, with the maximum value as the swallowing sound index. We examined the correlation between the swallowing sound index and patient background, including swallowing-related parameters. Results We evaluated 24 patients with ALS (age 64.0 ± 11.8 years, 13 women, median duration of illness 17.5 months). The median ALS Functional Rating Scale-Revised (ALSFRS-R) score was 41 (minimum 18, maximum 47). In all cases, the mean swallowing sound index was 0.209 ± 0.088. A multivariate analysis showed that a decrease in the swallowing sound index was significantly associated with a low ALSFRS-R score, an ALSFRS-R bulbar symptom score, % vital capacity, tongue pressure, a Mann Assessment of Swallowing Ability (MASA) score, and a MASA pharyngeal phase-related score. Conclusion Swallowing sound evaluation using an electronic stethoscope AI analysis showed a correlation with existing indicators in swallowing evaluation in ALS and suggested its usefulness as a new method. This is expected to be a useful examination method in home and remote medical care.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ruoyi Ishikawa
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoaki Watanabe
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tamayo Takahashi
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Simizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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14
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Cheriyan SS, Schar MS, Woods CM, Bihari S, Cock C, Athanasiadis T, Omari TI, Ooi EH. Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls. CRIT CARE RESUSC 2023; 25:97-105. [PMID: 37876599 PMCID: PMC10581277 DOI: 10.1016/j.ccrj.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients. Design Cohort study. Setting Australian tertiary hospital intensive care unit. Participants Tracheostomised adults, planned for decannulation. Main outcome measures Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls. Results In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (p < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] v tracheostomy 13.7 mmHg [10.4, 16.9], P < 0.001; control -4.28 mmHg [-5.87, 2.69] v tracheostomy 12.2 mmHg [8.83, 15.6], P < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], P < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] v tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; P = 0.001). Conclusion In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.
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Affiliation(s)
- Sanith S. Cheriyan
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Mistyka S. Schar
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Speech Pathology and Audiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Charmaine M. Woods
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Shailesh Bihari
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Intensive & Critical Care, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Charles Cock
- Department of Gastroenterology & Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Theodore Athanasiadis
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Taher I. Omari
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Eng H. Ooi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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15
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Kochi K, Sei H, Tanabe Y, Yasuda K, Kido T, Yamada H, Taguchi A, Hato N. The dynamics of deglutition during head rotation using dynamic 320-row area detector computed tomography. Laryngoscope Investig Otolaryngol 2023; 8:746-753. [PMID: 37342115 PMCID: PMC10278121 DOI: 10.1002/lio2.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
Objective We aimed to elucidate the dynamics of deglutition during head rotation by acquiring 320-row area detector computed tomography (320-ADCT) images and analyzing deglutition during head rotation. Methods This study included 11 patients experiencing globus pharyngeus. A 320-ADCT was used to acquire images in two types of viscosity (thin and thick), with the head rotated to the left. We measured the movement time of deglutition-related organs (soft palate, epiglottis, upper esophageal sphincter [UES], and true vocal cords) and pharyngeal volume (bolus ratio at the start of UES opening [Bolus ratio], pharyngeal volume contraction ratio [PVCR], and pharyngeal volume before swallowing [PVBS]). A two-way analysis of variance was performed for statistical analysis, and all items were compared for significant differences in terms of head rotation and viscosity. EZR was used for all statistical analyses (p-value <.05). Results Head rotation significantly accelerated the onset of epiglottis inversion and UES opening compared with no head rotation. The duration of epiglottis inversion with the thin viscosity fluid was significantly longer. The bolus ratio increased significantly with thick viscosity. There was no significant difference in viscosity and head rotation in terms of PVCR. PVBS increased significantly with head rotation. Conclusion The significantly earlier start of epiglottis inversion and UES opening due to head rotation could be caused by: (1) swallowing center; (2) pharyngeal volume; and (3) pharyngeal contraction force. Thus, we plan to further analyze swallowing with head rotation by combining swallowing CT with manometry and examine its relationship with pharyngeal contraction force. Level of Evidence 3b.
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Affiliation(s)
- Kazutaka Kochi
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck SurgeryEhime Prefectural Central HospitalMatsuyamaEhimeJapan
- Department of Mechanical Systems Engineering, Graduate School of Science and EngineeringYamagata UniversityYonezawa CityJapan
| | - Yuki Tanabe
- Department of RadiologyEhime University Graduate School of MedicineToon CityJapan
| | - Kazunori Yasuda
- Department of Mechanical Engineering, Graduate School of Science and EngineeringEhime UniversityMatsuyama CityJapan
| | - Teruhito Kido
- Department of RadiologyEhime University Graduate School of MedicineToon CityJapan
| | - Hiroyuki Yamada
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
| | - Aki Taguchi
- Faculty of Health and WelfarePrefectural University of HiroshimaMiharaJapan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
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16
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Mialland A, Atallah I, Bonvilain A. Toward a robust swallowing detection for an implantable active artificial larynx: a survey. Med Biol Eng Comput 2023; 61:1299-1327. [PMID: 36792845 DOI: 10.1007/s11517-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.
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Affiliation(s)
- Adrien Mialland
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France.
| | - Ihab Atallah
- Institute of Engineering and Management Univ. Grenoble Alpes, Otorhinolaryngology, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Agnès Bonvilain
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France
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17
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Omari T, Cock C, Wu P, Szczesniak MM, Schar M, Tack J, Rommel N. Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders. Neurogastroenterol Motil 2023; 35:e14461. [PMID: 36121685 DOI: 10.1111/nmo.14461] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oro-pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high-resolution manometry impedance (P-HRM-I). We aimed to establish methodology to diagnose disorders utilizing P-HRM-I, hypothesizing that the objective measures could be used to diagnose disordered deglutition evidenced by greater aspiration scores. METHODS Patients (n = 509, 18-91 years) were compared to controls (n = 120, 20-94 years). Variables measuring UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contractile strength were derived for 10 ml liquid swallows. Three associated pharyngeal pressurization patterns, which may be indicative of obstructed flow, were characterized: pan-pressurization (Type 1), distal compartmentalized pressurization (Type 2), and transient pressurization (Type 3). Deglutitive aspiration was determined from video fluoroscopy. RESULTS UES relaxation pressure was best able to differentiate patients from controls (T 6.528, p < 0.0001). Patients with abnormal relaxation pressure (>8 mmHg) more frequently exhibited pharyngeal pressurization patterns and had adjunct evidence of reduced luminal distensibility (high intrabolus pressure and/or reduced UES opening). Utilizing this information, a diagnostic scheme was devised identifying 138 patients with UES disorder. A further 96 patients without evidence of UES disorder had abnormally weak pharyngeal pressures, confirming propulsive disorder. Amongst a sub-sample of 320 patients undergoing video fluoroscopy, those with pharyngeal pressurizations and adjunct evidence of reduced UES relaxation and/or distensibility had higher aspiration scores (Chi-square 60.169, p < 0.0001). CONCLUSION P-HRM-I can provide evidence for UES disorder based on pharyngeal pressurization patterns and abnormal findings for UES relaxation pressure, UES opening, and intrabolus pressure. Measuring pharyngeal contractility requires further optimization.
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Affiliation(s)
- Taher Omari
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Peter Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Michal Marcin Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Mistyka Schar
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jan Tack
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium
| | - Nathalie Rommel
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium.,Deglutology, Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium
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18
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Hung JS, Liang SW, Omari T, Wong MW, Lei WY, Yi CH, Liu TT, Lin L, Chen CL. Effects of the GABA(B) agonist baclofen on volitional swallowing in normal subjects. Kaohsiung J Med Sci 2023; 39:80-86. [PMID: 36245436 DOI: 10.1002/kjm2.12607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 01/15/2023] Open
Abstract
The GABA(B) receptor agonist baclofen is known to suppress the rate of spontaneous swallowing but not pharyngeal muscle contraction. The extent to which baclofen may alter volitional swallowing is not currently known. We investigated the effects of baclofen in healthy subjects, hypothesizing that baclofen exposure would alter volume-regulation and/or piecemeal deglutition behaviors during volitional swallowing attempts. Pharyngeal high-resolution manometry impedance (P-HRM-I) protocol was used to assess swallowing function of 22 healthy adult volunteers (median 29 years) who were investigated on two occasions, receiving 40 mg baclofen (oral) 1 h before study, or placebo (randomized). Standard swallow function variables recommended by the pharyngeal HRM Working Group were derived for 5 ml, 10 ml, and 20 ml volumes of thin and extremely thick liquid challenges. Multiple swallow behaviors, comprising two swallows <5 s apart, were characterized. The spontaneous swallow rate was also determined. Baclofen exposure had no overall significant effect on swallow variables. Upper esophageal sphincter pressure was weaker during exposure to baclofen, during both the pre-deglutitive and post-deglutitive phases of the swallow (p < 0.05 during thick liquid swallows). Piecemeal swallows, where the bolus is separated in two potions, were significantly more common during 20 ml boluses (p = 0.002). Baclofen decreased the frequency of piecemeal deglutition overall. Baclofen has limited to no effect on volitional swallowing measures, however, does reduce the likelihood of initiation of piecemeal deglutition to large volume challenges.
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Affiliation(s)
- Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Shu-Wei Liang
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Taher Omari
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Lin Lin
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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19
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Accuracy of High-Resolution Pharyngeal Manometry Metrics for Predicting Aspiration and Residue in Oropharyngeal Dysphagia Patients with Poor Pharyngeal Contractility. Dysphagia 2022; 37:1560-1575. [PMID: 35182246 DOI: 10.1007/s00455-022-10417-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
Several physiological metrics can be derived from pharyngeal high-resolution impedance manometry (HRPM), but their clinical relevance has not been well established. We investigated the diagnostic performance of these metrics in relation to videofluoroscopic (VFS) assessment of aspiration and residue in patients with oropharyngeal dysphagia. We analyzed 263 swallows from 72 adult patients (22-91 years) with diverse medical conditions. Metrics of contractility, upper esophageal sphincter (UES) opening and relaxation, flow timing, intrabolus distension pressure, and a global Swallow Risk Index (SRI) were derived from pressure-impedance recordings using pressure-flow analysis. VFS data were independently scored for airway invasion and pharyngeal residue using the Penetration-Aspiration Scale and the Normalized Residue Ratio Scale, respectively. We performed multivariate logistic regression analyses to determine the relationship of HRPM metrics with radiological outcomes and receiver-operating characteristic (ROC) analysis to evaluate their diagnostic accuracy. We identified aspiration in 25% and pharyngeal residue in 84% of the swallows. Aspiration was independently associated with hypopharyngeal peak pressure < 65 mmHg (HypoPeakP) [adjusted odds ratio (OR) 5.27; 95% Confidence Interval (CI) (0.99-28.1); p = 0.051], SRI > 15 [OR 4.37; 95% CI (1.87-10.2); p < 0.001] and proximal esophageal contractile integral (PCI) < 55 mmHg·cm·s [OR 2.30; 95% CI (1.07-4.96); p = 0.034]. Pyriform sinus residue was independently predicted by HypoPeakP < 65 mmHg [OR 7.32; 95% CI (1.93-27.7); p = 0.003], UES integrated relaxation pressure (UES-IRP) > 3 mmHg [OR 2.96; 95% CI (1.49-5.88); p = 0.002], and SRI > 15 [OR 2.17; 95% CI (1.04-4.51); p = 0.039]. Area under ROC curve (AUC) values for individual HRPM metrics ranged from 0.59 to 0.74. Optimal cut-off values were identified. This study demonstrates the diagnostic value of certain proposed and adjunct HRPM metrics for identifying signs of unsafe and inefficient bolus transport in patients with oropharyngeal dysphagia.
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20
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Does Medialization Improve Swallowing Function in Patients with Unilateral Vocal Fold Paralysis? A Systematic Review. Dysphagia 2022; 37:1769-1776. [PMID: 35412149 DOI: 10.1007/s00455-022-10441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
Glottal incompetence caused by unilateral vocal fold paralysis (UVFP) is a common cause of dysphagia and aspiration. Treatments targeted at reducing glottal incompetence by injection augmentation or medialization thyroplasty are well established at improving voice outcomes, but improvements in swallowing function are less clear. The objective of this systematic review was to determine the impact of vocal fold medialization on dysphagia outcomes. Six electronic bibliographic databases and one clinical trial registry were searched on 3/13/2020. Our patient population were adult patients with verified UVFP that underwent vocal fold medialization. We limited review to prospective studies that had formal dysphagia assessment both before and after medialization. Nine studies met selection criteria (7 prospective case series and 2 prospective cohort studies) totaling 157 patients. The most common etiology of UVFP was iatrogenic (74/157; 47%). The majority of patients underwent injection augmentation (92/157; 59%), and the remaining underwent medialization thyroplasty. A variety of methods were used to assess changes in dysphagia including patient-reported outcome measures, flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, and high-resolution manometry. 7/9 studies demonstrated clinically significant improvement in swallowing function following medialization; 4/9 studies demonstrated statistically significant improvement, and three studies did not show statistically significant improvement after intervention. Study participants and outcome measures evaluating swallowing function in this review were heterogeneous. Moreover, the reviewed studies are concerning for multiple risks of bias impacting their conclusions. Taken together, this systematic review demonstrates limited evidence that injection augmentation and medialization thyroplasty improve swallowing function and/or safety.
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21
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Zhang X, Liang Y, Wang X, Shan Y, Xie M, Li C, Hong J, Chen J, Wan G, Zhang Y, Lin Y, Zhao F, He Z, Dou Z, Wen H. Effect of Modified Pharyngeal Electrical Stimulation on Patients with Severe Chronic Neurogenic Dysphagia: A Single-Arm Prospective Study. Dysphagia 2022:10.1007/s00455-022-10536-z. [DOI: 10.1007/s00455-022-10536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
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22
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Montoro-Huguet MA. Dietary and Nutritional Support in Gastrointestinal Diseases of the Upper Gastrointestinal Tract (I): Esophagus. Nutrients 2022; 14:nu14224819. [PMID: 36432505 PMCID: PMC9697263 DOI: 10.3390/nu14224819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The esophagus is the centerpiece of the digestive system of individuals and plays an essential role in transporting swallowed nutrients to the stomach. Diseases of the esophagus can alter this mechanism either by causing anatomical damage that obstructs the lumen of the organ (e.g., peptic, or eosinophilic stricture) or by generating severe motility disorders that impair the progression of the alimentary bolus (e.g., severe dysphagia of neurological origin or achalasia). In all cases, nutrient assimilation may be compromised. In some cases (e.g., ingestion of corrosive agents), a hypercatabolic state is generated, which increases resting energy expenditure. This manuscript reviews current clinical guidelines on the dietary and nutritional management of esophageal disorders such as severe oropharyngeal dysphagia, achalasia, eosinophilic esophagitis, lesions by caustics, and gastroesophageal reflux disease and its complications (Barrett's esophagus and adenocarcinoma). The importance of nutritional support in improving outcomes is also highlighted.
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Affiliation(s)
- Miguel A. Montoro-Huguet
- Unit of Gastroenterology, Hepatology & Nutrition, University Hospital San Jorge, 22005 Huesca, Spain;
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- Aragón Health Sciences Institute (IACS), 50009 Zaragoza, Spain
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Aceves SS, Alexander JA, Baron TH, Bredenoord AJ, Day L, Dellon ES, Falk GW, Furuta GT, Gonsalves N, Hirano I, Konda VJA, Lucendo AJ, Moawad F, Peterson KA, Putnam PE, Richter J, Schoepfer AM, Straumann A, McBride DL, Sharma P, Katzka DA. Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference. Gastrointest Endosc 2022; 96:576-592.e1. [PMID: 35965102 DOI: 10.1016/j.gie.2022.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022]
Abstract
Endoscopy plays a critical role in caring for and evaluating the patient with eosinophilic esophagitis (EoE). Endoscopy is essential for diagnosis, assessment of response to therapy, treatment of esophageal strictures, and ongoing monitoring of patients in histologic remission. To date, less-invasive testing for identifying or grading EoE severity has not been established, whereas diagnostic endoscopy as integral to both remains the criterion standard. Therapeutic endoscopy in patients with adverse events of EoE may also be required. In particular, dilation may be essential to treat and attenuate progression of the disease in select patients to minimize further fibrosis and stricture formation. Using a modified Delphi consensus process, a group of 20 expert clinicians and investigators in EoE were assembled to provide guidance for the use of endoscopy in EoE. Through an iterative process, the group achieved consensus on 20 statements yielding comprehensive advice on tissue-sampling standards, gross assessment of disease activity, use and performance of endoscopic dilation, and monitoring of disease, despite an absence of high-quality evidence. Key areas of controversy were identified when discussions yielded an inability to reach agreement on the merit of a statement. We expect that with ongoing research, higher-quality evidence will be obtained to enable creation of a guideline for these issues. We further anticipate that forthcoming expert-generated and agreed-on statements will provide valuable practice advice on the role and use of endoscopy in patients with EoE.
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Affiliation(s)
- Seema S Aceves
- Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Jeffrey A Alexander
- Departments of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Arjan J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lukejohn Day
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gary W Falk
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Glenn T Furuta
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Fouad Moawad
- Scripps Health Uniformed Services, La Jolla, California, USA
| | - Kathryn A Peterson
- Division of Gastroenterology, Hepatology, and Nutrition, University of Utah Health, Salt Lake City, Utah, USA
| | - Philip E Putnam
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joel Richter
- University of South Florida Health, Tampa, Florida, USA
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausannel, Lausanne, Switzerland
| | - Alex Straumann
- Facharzt FMH fur Gastroenterologie u Innere Medizin, Olten, Switzerland
| | | | - Prateek Sharma
- Division of Gastroenterology, Hepatology, and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David A Katzka
- Division of Gastroenterology, Columbia University Medical Center, New York, New York, USA
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24
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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25
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Schar MS, Omari TI, Woods CM, Footner LR, Marshall N, Cock C, Thompson A, Nguyen T, Athanasiadis T, Ooi EH. Pharyngeal tongue base augmentation for dysphagia therapy: A prospective case series in patients post head and neck cancer treatment. Head Neck 2022; 44:1871-1884. [PMID: 35665556 DOI: 10.1002/hed.27104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysphagia post head and neck cancer (HNC) multimodality treatment is attributed to reduced pharyngeal strength. We hypothesized that pharyngeal tongue base augmentation for dysphagia (PAD therapy) would increase pharyngeal pressures during swallowing thereby improving swallow symptoms. METHODS Adults with moderate-severe dysphagia post-HNC treatment had PAD therapy using a temporary filler (hyaluronic acid [HA]), with follow-up long-lasting lipofilling. Swallowing preprocedure and postprocedure was assessed with the Sydney Swallow Questionnaire (SSQ), High-Resolution Pharyngeal Manometry (HRPM), and Videofluoroscopic Swallowing Study (VFSS). Statistical comparison utilized paired tests. RESULTS Six participants (all male; median age 64 years [IQR 56, 71]) underwent PAD therapy at a median of 47 [IQR 8, 95] months post-treatment. SSQ scores reduced from baseline (mean 1069 [95%CI 703, 1434]) to post-HA (mean 579 [76, 1081], p > 0.05), and post-lipofilling (491 [95%CI 913, 789], p = 0.003, n = 4). Individual participants demonstrated reduced Swallow Risk Index, Bolus Presence Time, and increased Upper Esophageal Sphincter opening, but mesopharyngeal contractile pressures were unchanged. VFSS measures of aspiration, residue, and severity were unchanged. CONCLUSIONS Novel PAD therapy is safe and improves dysphagia symptoms. Biomechanical swallowing changes are suggestive of more efficacious bolus propulsion with conservative filler volume, but this was unable to resolve residue or aspiration measures.
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Affiliation(s)
- Mistyka S Schar
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lauren R Footner
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicholas Marshall
- Department of Plastics & Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Alison Thompson
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Thi Nguyen
- South Australian Medical Imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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Omari T, Rommel N, Jan T, Szczesniak M, Wu P, Schar M, Doeltgen S, Cock C. Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant? Neurogastroenterol Motil 2022; 34:e14276. [PMID: 34606649 DOI: 10.1111/nmo.14276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/23/2021] [Accepted: 09/19/2021] [Indexed: 12/08/2022]
Abstract
INTRODUCTION In oropharyngeal dysphagia, impaired pharyngoesophageal junction (PEJ) opening is reflected by an elevated hypopharyngeal intrabolus pressure (IBP), quantifiable using pharyngeal high-resolution manometry with impedance (P-HRM-I). Transient intrabolus pressurization (TP) phenomena are not sustained and last for only a brief period. We hypothesized that TP patterns reflect impaired coordination between timing of hypopharyngeal bolus arrival and PEJ relaxation. METHODS A retrospective audit was conducted of P-HRM-I datasets; 93 asymptomatic Controls and 214 Patients with differing etiological/clinical backgrounds were included. TP patterns were examined during 10ml liquid swallows. TP was defined by a simultaneous, non-sustained, pressurization wave spanning from the velo-/meso-pharynx to PEJ. The coordination between deglutitive pharyngeal bolus distension and PEJ relaxation timing was assessed using timing variables; (i) Distention-Contraction Latency (DCL, s) and (ii) PEJ Relaxation Time (RT, s). Resultant flow resistance was quantified (IBP, mmHg). RESULTS TP swallows were observed in 87 (28%) cases. DCL was not significantly different in relation to TP, while PEJ relaxation time was shorter, and IBP was higher during TP swallows. In Patients RT-DCL time difference correlated with IBP (r -0.368, p < 0.01). CONCLUSION Bolus distension and PEJ relaxation were miss-timed during TP swallows, impeding bolus flow and leading to a brief period of pressurization of the pharyngeal chamber by muscular propulsive forces. While TP swallows were identified in both Controls and Patients, increased IBPs were most apparent for Patient swallows indicating that the extent of IBP increase may differentiate pathological TP swallows.
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Affiliation(s)
- Taher Omari
- Flinders Health and Medical Research Institute (FHMRI) & College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Nathalie Rommel
- Deglutology, Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium.,Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Belgium
| | - Tack Jan
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Belgium
| | - Michal Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Mistyka Schar
- Flinders Health and Medical Research Institute (FHMRI) & College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute (FHMRI) & College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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27
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Heslin N, Regan J. Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:190-199. [PMID: 34607470 DOI: 10.1080/17549507.2021.1975817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Evidence base to support the use of the effortful swallow in clinical populations with dysphagia is currently lacking. This study aims to quantify the effects of effortful swallowing on pharyngeal swallowing biomechanics in adults with dysphagia using pharyngeal high-resolution manometry (PHRM).Method: ManoScan HRM equipment with a 4.2 mm pressure catheter was used. Participants completed duplicate 10ml baseline and 10ml effortful liquid (IDDSI Level 0) swallows in randomised order. PHRM data were analysed using a semi-automated online platform (www.swallowgateway.com).Result: Fifteen adults (8 males; range 45-86 years) with mixed aetiology dysphagia (Functional Oral Intake Scale Level 2-5) were included. Median pharyngeal contractile (156.81 mmHg cm s; IQR 80.62) increased significantly (213.50 mmHg cm s; IQR 117.2) during effortful swallowing. Significant increases were also observed in velopharyngeal pressure, mesopharyngeal pressure, hypopharyngeal pressure and upper oesophageal sphincter (UOS) relaxation duration. UOS integrated relaxation pressure (IRP) was not significantly altered with effortful swallowing.Conclusion: Effortful swallowing induced significant biomechanical changes to swallow in adults with dysphagia. Increases in global pharyngeal rigour, tongue base pressure and UOS opening duration were captured by PHRM during effortful swallowing. Further investigation in larger homogeneous clinical populations is needed to verify the physiological effects of this frequently employed intervention.
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Affiliation(s)
- Niall Heslin
- Department of Clinical Speech & Language Studies, Trinity College, Dublin, Ireland
| | - Julie Regan
- Department of Clinical Speech & Language Studies, Trinity College, Dublin, Ireland
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28
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Szczesniak MM, Omari TI, Lam TY, Wong M, Mok VCT, Wu JCY, Chiu PWY, Yuen MTY, Tsang RK, Cock C, Sung JJ, Wu P. Evaluation of oropharyngeal deglutitive pressure dynamics in patients with Parkinson's disease. Am J Physiol Gastrointest Liver Physiol 2022; 322:G421-G430. [PMID: 35138164 DOI: 10.1152/ajpgi.00314.2021] [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] [Indexed: 01/31/2023]
Abstract
In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood. The aim of the study was to determine the changes in oropharyngeal deglutitive pressure dynamics in PD and to correlate these with clinical characteristics including dysphagia and PD severity. In prospective consecutive series of 64 patients with PD [mean age: 66.9 ± 8.3 (SD)], we evaluated dysphagia severity clinically as well as with Sydney Swallow Questionnaire (SSQ) and Swallow Quality-of-Life Questionnaire (SWAL-QOL). PD severity was assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We used high-resolution pharyngeal impedance manometry (HRPIM) to objectively evaluate swallow function and compared data from 23 age-matched healthy controls [mean age 62.3 ± 9.1 (SD)]. Metrics assessed were upper esophageal sphincter (UES), integrated relaxation pressure (IRP), relaxation time (RT), maximum opening (MaxAdm), and pharyngeal intrabolus pressure (IBP) and pharyngeal contractility (PhCI). Mean MDS-UPDRS score was positively associated with dysphagia severity on SSQ and SWAL-QOL. HRPIM in PD compared with controls showed impaired UES relaxation parameters, with shorter RT, and elevated IRP and IBP. MaxAdm was not affected. The overall pharyngeal contractility was significantly higher in PD. Only the IBP and IRP were associated with PD severity and only IBP was significantly associated with dysphagia severity. UES dysfunction leading to increased flow resistance is common in patients with PD and correlates with dysphagia severity. Increased flow resistance may suggest impaired UES relaxation and/or impaired neuromodulation to bolus volume.NEW & NOTEWORTHY In Parkinson's disease, objective assessment of swallow function with high-resolution impedance manometry identifies upper esophageal sphincter dysfunction leading to increased flow resistance.
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Affiliation(s)
- Michal M Szczesniak
- St George and Sutherland Clinical School, University of NSW, Sydney, Australia.,Department of Gastroenterology and Hepatology, St. George Hospital, Sydney, Australia
| | - Taher I Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Thomas Y Lam
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Marc Wong
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Vincent C T Mok
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Justin C Y Wu
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Philip W Y Chiu
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Margaret T Y Yuen
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.,Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Raymond K Tsang
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Charles Cock
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Joseph J Sung
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Peter Wu
- St George and Sutherland Clinical School, University of NSW, Sydney, Australia.,Department of Gastroenterology and Hepatology, St. George Hospital, Sydney, Australia.,Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
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29
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Schar MS, Omari TI, Woods CM, Cock C, Doeltgen SH, Chai-Coetzer CL, Eckert DJ, Athanasiadis T, Ooi EH. Swallowing biomechanics before and following multi-level upper airway surgery for obstructive sleep apnea. J Clin Sleep Med 2022; 18:1167-1176. [PMID: 34913869 PMCID: PMC8974379 DOI: 10.5664/jcsm.9824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The effect of contemporary multi-level upper airway surgery for obstructive sleep apnea on swallowing is unclear. This study assessed the biomechanical swallowing function in participants with obstructive sleep apnea pre- and post-modified uvulopalatopharyngoplasty and coblation channeling of the tongue. METHODS In this prospective, longitudinal study, adults diagnosed with moderate-severe obstructive sleep apnea who underwent modified uvulopalatopharyngoplasty and coblation channeling of the tongue surgery had swallowing biomechanics assessed using high-resolution pharyngeal manometry and analyzed with swallowgateway.com. Symptomatic swallowing difficulty was evaluated using the Sydney Swallow Questionnaire (≥ 234). General linear mixed-model analysis was conducted to evaluate the difference pre- and post-modified uvulopalatopharyngoplasty and coblation channeling of the tongue. Data are presented as mean [95% confidence intervals]. RESULTS High-resolution pharyngeal manometry assessments were conducted in 10 participants (7 men; median age 50 [interquartile range 36-65]) preoperatively and repeated postoperatively at 9 months [interquartile range 6-13]. Self-reported dysphagia was unchanged following surgery (Sydney Swallow Questionnaire =149 [53, 447] to 168 [54, 247]; P = .093). High-resolution pharyngeal manometry outcomes indicated reduced mesopharyngeal pressures (148 [135, 161] to 124 [112, 137] mm Hg s cm; P = .011), reduced hypopharyngeal pressures (113 [101, 125] to 93 [84, 102] mm Hg s cm; P = 0.011), and reduced upper esophageal sphincter relaxation pressure (5 [4, 6] to 2 [1,3] mm Hg; P = 0.001) but no change to velopharyngeal pressures (135 [123, 147] to 137 [117, 157] mm Hg s cm; P = .850) postsurgery. CONCLUSIONS Modified uvulopalatopharyngoplasty may have less implications on the swallow mechanism than previously suspected. In contrast, the reduction in mesopharyngeal contractile pressures associated with coblation channeling of the tongue, although within normal limits, may affect bolus propulsion. Biomechanical alterations were insufficient to worsen self-reported swallowing function. CITATION Schar MS, Omari TI, Woods CW, et al. Swallowing biomechanics before and following multi-level upper airway surgery for obstructive sleep apnea. J Clin Sleep Med. 2022;18(4):1167-1176.
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Affiliation(s)
- Mistyka S. Schar
- Department of Speech Pathology, Flinders Medical Centre, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Taher I. Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Charmaine M. Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sebastian H. Doeltgen
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University Adelaide, South Australia, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- Respiratory and Sleep Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Danny J. Eckert
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H. Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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30
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Lai CJ, Cheng YJ, Lai DM, Wu CY, Chang WT, Tsuang FY. Applying High-Resolution Impedance Manometry for Detecting Swallowing Change in Anterior Cervical Spine Surgery Patients. Front Surg 2022; 9:851126. [PMID: 35372473 PMCID: PMC8965755 DOI: 10.3389/fsurg.2022.851126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Objectively detecting perioperative swallowing changes is essential for differentiating the reporting of subjective trouble sensations in patients undergoing anterior cervical spine surgery (ACSS). Swallowing indicates the transmission of fluid boluses from the pharynx (velopharynx, oropharynx, and hypopharynx) through the upper esophageal sphincter (UES). Abnormal swallowing can reveal fluid accumulation at the pharynx, which increased the aspiration risk. However, objective evidence is limited. High-resolution impedance manometry (HRIM) was applied for an objective swallowing evaluation for a more detailed analysis. We aimed to elucidate whether HRIM can be used to detect perioperative swallowing changes in patients undergoing ACSS. Methods Fourteen patients undergoing elective ACSS underwent HRIM with the Dysphagia Short Questionnaire (DSQ, score: 0–18) preoperatively (PreOP), on postoperative at day 1 (POD1), and postoperative at day seven (POD7). We calculated hypopharyngeal and UES variables, including hypopharyngeal mean peak pressure (PeakP) and UES peak pressure, representing their contractility (normal range of PeakP, 69–280 mmHg; peak pressure, 149–548 mmHg). The velopharynx-to-tongue base contractile (VTI) was also calculated (normal range, 300–700 mmHg.s.cm), indicating contractility. The swallowing risk index (SRI) from HRIM combined with four hypopharyngeal parameters, including PeakP, represents the global swallowing function (normal range, 0–11). A higher SRI value indicated higher aspiration. Results SRI was significantly higher on POD1 (10.88 ± 5.69) than PreOP (6.06 ± 3.71) and POD7 (8.99 ± 4.64). In all patients, PeakP was significantly lower on POD1 (61.8 ± 18.0 mmHg) than PreOP (84.9 ±34.7 mmHg) and on POD7 (75.3 ± 23.4 mmHg). The UES peak pressure was significantly lower on POD1 (80.4 ± 30.0 mmHg) than PreOP (112.9 ± 49.3 mmHg) and on POD7 (105.6 ± 59.1 mmHg). Other variables, including VTI, did not change significantly among the three time points. DSQ scores were 1.36, 3.43, and 2.36 at PreOP, POD1, and POD7 respectively. Conclusions With similar trends in DSQ and SRI, swallowing was significantly decreased on POD1 because of decreased hypopharyngeal and UES contractility but recovered to the preoperative state on POD7 after ACSS. Applying HRIM is superior to DSQ in detecting mechanisms and monitoring the recovery from swallowing dysfunction. Clinical Trial Registration The study was registered at ClinicalTrials.gov (NCT03891940).
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Ting Chang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Fon-Yih Tsuang
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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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32
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Kwong SL, Hernandez EG, Winiker K, Gozdzikowska K, Macrae P, Huckabee ML. Effect of Topical Nasal Anesthetic on Comfort and Swallowing in High-Resolution Impedance Manometry. Laryngoscope 2022; 132:2124-2131. [PMID: 34989412 DOI: 10.1002/lary.30010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Use of topical nasal anesthetic (TNA) is common in high-resolution impedance manometry (HRIM). This study investigated the effect of TNA on swallowing and procedure tolerability during HRIM with a 4.2-mm catheter, a more commonly used catheter size with impedance capabilities. STUDY DESIGN Randomised experimental study with blinding of participants. METHODS Twenty healthy participants (mean age = 33 years, 16 female) were randomized to undergo HRIM using the ManoScan™ ESO Z 4.2-mm catheter twice, 1 week apart, under two conditions: with TNA (viscous lidocaine) and with placebo. Analyses included esophageal data of three saliva, three saline (5 mL), and three bread swallows (2 cm × 2 cm) performed while reclined 45°, and pharyngeal data under the same conditions while seated upright. Pharyngeal and upper esophageal sphincter (UES) HRIM parameters were analyzed using the Swallow Gateway analysis platform. Visual analogue scale (VAS) scores rating procedural comfort were analyzed. RESULTS There were no significant physiological differences in pharyngeal and UES parameters between conditions. There were also no significant differences in VAS scores under placebo (mean = 54.8, standard deviation (SD) = 19.3) and TNA (mean = 60.0, SD = 21.9) (t[19] = -0.9, P = .4) conditions; however, there was a significant difference in the first versus second session (t[19]) = 5.1, P < .05). CONCLUSIONS TNA did not improve comfort, but it also did not significantly affect swallowing behavior. There was, however, a practice effect regardless of TNA use with improved tolerance of the 4.2-mm catheter and likely more natural swallowing behavior during the second session of HRIM. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Seh Ling Kwong
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand.,Tan Tock Seng Hospital, Singapore
| | - Ester G Hernandez
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Katharina Winiker
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand.,Swiss University of Speech and Language Sciences SLHR, Rorschach, Switzerland
| | - Kristin Gozdzikowska
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand.,Research and Innovation, University of Canterbury, Christchurch, New Zealand
| | - Phoebe Macrae
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
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Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review. Dysphagia 2022; 37:1697-1714. [PMID: 35235032 PMCID: PMC9643180 DOI: 10.1007/s00455-022-10418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
There has been a recent shift towards proactive dysphagia intervention in motor neurone disease (MND) to maintain physiological reserve. Pharyngeal high-resolution manometry (PHRM) can quantify swallowing pathophysiology to inform and evaluate proactive dysphagia intervention. This study aims to explore the current use of PHRM as a dysphagia evaluation in adults with MND. A scoping review based on the Joanna Briggs Framework was completed. Four electronic databases (PubMed, EMBASE, CINAHL and Web of Science core) were searched (inception to March 2021) by two independent researchers. Data were analysed according to (i) PHRM protocol and analysis methods and the feasibility of same, (ii) swallow biomechanics data and (iii) dysphagia intervention effects as measured by PHRM. Six studies with 78 people with MND (PwMND) were included. There was considerable variation in PHRM protocol and analysis methods. Five studies reported a 100% completion rate and three studies reported no adverse events. Swallow biomechanics data were reported across all studies. The effects of sensory stimulation, increased bolus consistency, effortful swallow and cricopharyngeal myotomy were evaluated using PHRM with 20 PwMND across four studies with varying effects. Literature on the use of PHRM in PwMND is limited. Variability in PHRM methods restricts comparison of metrics. PHRM appears to be a feasible tool for PwMND. PHRM can provide novel swallow physiology data in PwMND and quantify discrete effects of compensatory and surgical dysphagia interventions not detectable by videofluoroscopy or FEES. Further research on the effects of proactive dysphagia intervention as measured by PHRM is required.
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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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Schindler A, Baijens LWJ, Geneid A, Pizzorni N. Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES. Eur Arch Otorhinolaryngol 2021; 279:2727-2742. [PMID: 34779927 PMCID: PMC8591442 DOI: 10.1007/s00405-021-07161-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022]
Abstract
Purpose Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in endoscopic assessment of the upper aerodigestive tract, the implementation of fiberoptic endoscopic evaluation of swallowing (FEES) was an almost self-evident evolution. This review aims to provide an update on FEES and the role of phoniatricians and otorhinolaryngologists using FEES in Europe. Methods A narrative review of the literature was performed by experts in the field of FEES both in the clinical context and in the field of scientific research. Results FEES is the first-choice OD assessment technique for both phoniatricians and otorhinolaryngologists. FEES is becoming increasingly popular because of its usefulness, safety, low costs, wide applicability, and feasibility in different clinical settings. FEES can be performed by health professionals of varying disciplines, once adequate knowledge and skills are acquired. FEES aims to determine OD nature and severity and can provide diagnostic information regarding the underlying etiology. The direct effect of therapeutic interventions can be evaluated using FEES, contributing to design the OD management plan. Standardization of FEES protocols and metrics is still lacking. Technological innovation regarding image resolution, frame rate frequency, endoscopic light source specifications, and endoscopic rotation range has contributed to an increased diagnostic accuracy. Conclusion The rising number of phoniatricians and otorhinolaryngologists performing FEES contributes to the early detection and treatment of OD in an aging European population. Nevertheless, a multidisciplinary approach together with other disciplines is crucial for the success of OD management.
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Affiliation(s)
- Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", Milan University, UOS Foniatria, ASST Fatebenefratelli-Sacco, Ospedale Sacco, Via GB Grassi 74, 20154, Milano, Italy.
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology-GROW, Maastricht University, Maastricht, The Netherlands
| | - Ahmed Geneid
- Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", Milan University, UOS Foniatria, ASST Fatebenefratelli-Sacco, Ospedale Sacco, Via GB Grassi 74, 20154, Milano, Italy
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Komatsu H, Furukawa T, Iritani K, Tatehara S, Takahashi M, Iwaki S, Kakei Y, Hasegawa T, Teshima M, Shinomiya H, Otsuki N, Hashikawa K, Kiyota N, Sasaki R, Akashi M, Nibu KI. Blowing time ratio and high-resolution manometry to evaluate swallowing function of patients with oral and oropharyngeal cancer. Auris Nasus Larynx 2021; 49:477-483. [PMID: 34789391 DOI: 10.1016/j.anl.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The blowing time ratio, which is the ratio of the blowing time when the nostrils are open and closed, is significantly correlated with velopharyngeal pressure, not only during speech but also during swallowing. This study aimed to further evaluate the usefulness of the blowing time ratio as a screening tool to evaluate the swallowing pressure of patients treated for oral and oropharyngeal cancers using high-resolution manometery (HRM). METHODS Ten patients treated for oral or oropharyngeal cancer were recruited for this study. Swallowing pressures at the velopharynx, oropharynx, and upper esophageal sphincter (UES) were measured using HRM. Their correlations with the blowing time ratio were analyzed. RESULTS The blowing time ratio was significantly correlated with the swallowing pressures of the oropharynx (CC = 0.815, p = 0.004) and the velopharynx (CC = 0.657, p = 0.039), but not of the UES. CONCLUSIONS The present results further support our previous finding that the blowing time ratio is a useful screening tool to evaluate velopharyngeal and oropharyngeal swallowing pressures in patients treated for oral and oropharyngeal cancer.
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Affiliation(s)
- Hirokazu Komatsu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Keisuke Iritani
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun Tatehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shinobu Iwaki
- Department of Rehabilitation, Kobe University Hospital
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Wu PI, Szczesniak MM, Omari T, Lam TY, Wong M, Maclean J, Ma KK, Chan AY, Mok V, Cook IJ, Cock C, Sung J, Wu J, Chiu PW. Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson's disease. Endosc Int Open 2021; 9:E1811-E1819. [PMID: 34790549 PMCID: PMC8589553 DOI: 10.1055/a-1562-7107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson's disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference -277.3, 95 %CI [-497.8, -56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference -10.1 mm Hg, 95 %CI [-16.3, -3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference -11.3 mm Hg, 95 %CI [-17.2, -5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.
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Affiliation(s)
- Peter I. Wu
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China,Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia,St George and Sutherland Clinical School, University of NSW, Sydney, Australia
| | - Michal M. Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia,St George and Sutherland Clinical School, University of NSW, Sydney, Australia
| | - Taher Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Thomas Y. Lam
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Marc Wong
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Julia Maclean
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia,St George and Sutherland Clinical School, University of NSW, Sydney, Australia
| | - Karen K. Ma
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Anne Y. Chan
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Vincent Mok
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Ian J. Cook
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia,St George and Sutherland Clinical School, University of NSW, Sydney, Australia
| | - Charles Cock
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Joseph Sung
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Justin Wu
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
| | - Philip W. Chiu
- Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, China
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Jones CA, Colletti CM. Age-Related Functional Reserve Decline Is Not Seen in Pharyngeal Swallowing Pressures. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3734-3741. [PMID: 34525307 PMCID: PMC9132052 DOI: 10.1044/2021_jslhr-21-00164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Functional reserve represents the difference between an individual's ability to produce a maximum output function and the ability to perform a functional task. Several studies have documented an age-related decrease in functional reserve with oral tongue pressure generation. Whether this pattern is seen in pharyngeal swallowing pressures is unknown. The aim of this study was to investigate pharyngeal functional reserve using high-resolution manometry during normal-effort and effortful swallows. Method Pharyngeal high-resolution manometry was performed on 38 younger healthy individuals (≤ 40 years) and 18 older healthy individuals (≥ 60 years) during normal-effort and effortful water swallows. Pressure metrics included maximum pressure in the velopharynx, tongue base, and hypopharynx, as well as pharyngeal contractile integral and minimum pressure in the upper esophageal sphincter (UES). Repeated-measures analysis of variance was used to determine the effects of swallow task, age, and pharyngeal region on pressure generation. Results Maximum pharyngeal pressures and pharyngeal contractile integral were significantly increased during the effortful swallows compared to normal-effort swallows (p < .001), but there were no interactions between task and age in pharyngeal pressures. In the UES, minimum pressures were significantly elevated in older individuals during effortful swallows compared to normal-effort swallows (p = .007) but did not follow a pattern consistent with reduced functional reserve. Conclusions Healthy individuals increase pharyngeal driving pressures during effortful swallows, without an age-related reduction in the magnitude of pressure increase. Thus, this study did not find evidence for an age-related reduction in pharyngeal functional reserve. The preserved ability to increase pharyngeal pressures during effortful swallowing in aging may support the use of behavioral swallowing interventions in older individuals without neuromuscular conditions. Supplemental Material https://doi.org/10.23641/asha.16606709.
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Affiliation(s)
- Corinne A. Jones
- Department of Neurology, Dell Medical School, The University of Texas at Austin
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin
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Fong R, Rumbach AF, Ward EC, Doeltgen SH, Sun N, Tsang R. Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo-esophageal dysphagia associated with nasopharyngeal cancer: A case series. Laryngoscope Investig Otolaryngol 2021; 6:1077-1087. [PMID: 34667851 PMCID: PMC8513417 DOI: 10.1002/lio2.641] [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: 03/13/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Problems with pharyngo-esophageal bolus flow have been reported following nasopharyngeal cancer (NPC) treatment. While studies using videofluoroscopic assessment have shown balloon dilation can help address this impairment, the impact of dilation on pressure and bolus flow characteristics incorporating high-resolution pharyngeal manometry (HRPM) has not been reported. METHODS Five cases with pharyngo-esophageal dysphagia post NPC underwent balloon dilation. Videofluoroscopic swallowing study (VFSS) and HRPM were completed before and 1 month post dilation. Oral intake and dysphagia related quality of life were reported to 3 months. RESULTS VFSS, manometry and functional outcomes revealed positive benefits from dilation in two cases. In the other three cases, two showed improvements on VFSS only. These three failed to make functional swallowing gains. CONCLUSIONS Where there was functional gain, both fluoroscopy and HRPM recorded improvement to UES function. Across the cases, response to dilation was variable and further work is needed to determine which patients would receive most benefit. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineThe Chinese University of Hong KongHong Kong
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Anna F. Rumbach
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Elizabeth C. Ward
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
- Centre of Functioning and Health Research, Metro South Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Sebastian H. Doeltgen
- Speech PathologyCaring Futures Institute, College of Nursing and Health Sciences, Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Nikie Sun
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
| | - Raymond Tsang
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong
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Hoffmeister JD, Ulmschneider CL, Jones CA, Ciucci MR, McCulloch TM. Measurement of Pharyngeal Air Pressure During Phonation Using High-Resolution Manometry. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3456-3464. [PMID: 34319775 PMCID: PMC8642091 DOI: 10.1044/2021_jslhr-21-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose The study of air pressure in the vocal tract is essential to understanding vocal function. Changes in vocal tract shape during different phonatory gestures are hypothesized to produce nonuniform air pressure across lower vocal tract locations. Current methods of air pressure measurement, however, are limited to a single location in the anterior oral cavity. The purposes of this study were (a) to assess the feasibility of a novel method of simultaneously measuring phonatory air pressure at multiple locations across the lower vocal tract using high-resolution pharyngeal manometry (HRM) and (b) to compare pressure across locations and among phonatory tasks. Method Two subjects underwent HRM while performing phonatory tasks. A catheter was passed transnasally and air pressure was measured simultaneously at five locations between the velopharyngeal port and the upper esophageal sphincter. Descriptive statistics were calculated for each location by task, and for each task averaged across locations. Results HRM was well tolerated, and air pressures from multiple locations in the lower vocal tract were able to be obtained simultaneously. During vocal tract semi-occlusion tasks, air pressures differed by location. Pressures averaged across locations demonstrated a pattern of increasing pressure with increasing semi-occlusion. Conclusions HRM is feasible for measuring air pressure simultaneously at multiple locations in the lower vocal tract during phonation with high spatial and temporal resolution, providing rich data to augment understanding of vocal function. The high spatial and temporal resolution yielded by this new method, paired with preliminary evidence that pressures change by location as a function of phonatory task, may be useful in future assays exploring differences in lower vocal tract air pressures between normal and disordered populations.
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Affiliation(s)
- Jesse D. Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin–Madison
| | | | - Corinne A. Jones
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin–Madison
- Neuroscience Training Program, University of Wisconsin–Madison
| | - Michelle R. Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin–Madison
- Neuroscience Training Program, University of Wisconsin–Madison
| | - Timothy M. McCulloch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin–Madison
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The upper esophageal sphincter in the high-resolution manometry era. Langenbecks Arch Surg 2021; 406:2611-2619. [PMID: 34462811 DOI: 10.1007/s00423-021-02319-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM). METHODS This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era. RESULTS We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation). CONCLUSION This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.
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Selvanderan S, Wong S, Holloway R, Kuo P. Dysphagia: clinical evaluation and management. Intern Med J 2021; 51:1021-1027. [PMID: 34278699 DOI: 10.1111/imj.15409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Dysphagia is a common problem affecting all ages. It is increasing in frequency particularly among the younger population due to the rising incidence of eosinophilic oesophagitis, a condition which often leads to acute presentation to hospital for the first time with food bolus obstruction requiring endoscopic removal. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus oesophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined by the eventual diagnosis, often in a multi-disciplinary setting.
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Affiliation(s)
- Shane Selvanderan
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephanie Wong
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Richard Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul Kuo
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Ghazanfar H, Shehi E, Makker J, Patel H. The Role of Imaging Modalities in Diagnosing Dysphagia: A Clinical Review. Cureus 2021; 13:e16786. [PMID: 34513393 PMCID: PMC8405125 DOI: 10.7759/cureus.16786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Dysphagia, which is characterized by difficulty in oro-gastric bolus transit, is a common condition. It is broadly classified into oropharyngeal or esophageal pathology. A wide array of differentials for dysphagia and initial clinical suspicion of oropharyngeal or esophagus etiology can assist in further evaluation. Fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS) are the preferred modalities for assessing oropharyngeal bolus transit, residual, as well as determining the risk of laryngeal aspiration. High-resolution pharyngeal manometry (HRPM) is an emerging modality for optimal topographical and pressure assessment of pharyngeal anatomy. HRPM provides improved assistance in evaluating the strength of the pharyngeal muscular contraction. Esophagogastroduodenoscopy (EGD) is the preferred exam for patients with suspected esophageal etiology of dysphagia. Barium swallow provides luminal assessment and assists in evaluating esophageal motility; it is non-invasive, but therapeutic interventions like biopsy cannot be performed. High-resolution esophageal manometry (HREM) has added another dimension in the diagnosis of esophageal motility disorders. The purpose of this review article is to help internists and primary care providers get a better understanding of the role of various imaging modalities in diagnosing dysphagia in the elderly population. This article also provides a comprehensive review and detailed comparison of these imaging modalities based on the latest evidence.
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Affiliation(s)
| | - Elona Shehi
- Medicine/Gastroenterology, Bronxcare Health System, Bronx, USA
| | - Jasbir Makker
- Gastroenterology, Bronxcare Hospital Center, Bronx, USA
| | - Harish Patel
- Internal Medicine, Bronxcare Hospital Center, Bronx, USA
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Winiker K, Gozdzikowska K, Guiu Hernandez E, Kwong SL, Macrae P, Huckabee ML. Potential for Behavioural Pressure Modulation at the Upper Oesophageal Sphincter in Healthy Swallowing. Dysphagia 2021; 37:763-771. [PMID: 34136950 DOI: 10.1007/s00455-021-10324-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
Supratentorial structures are known to be involved in the neural control of swallowing, thus the potential for volitional manipulation of pharyngeal swallowing is of rehabilitative interest. The extent of volitional control of the upper oesophageal sphincter (UOS) during swallowing remains unclear. Prior research has shown that the UOS opening duration can be volitionally prolonged during execution of the Mendelsohn manoeuvre, which does not change the UOS opening time in isolation but the swallowing response in its entirety. This study explored the capacity of healthy adults to increase the period of pressure drop in the region of the UOS (UOS-Pdrop) during swallowing, through volitional UOS pressure modulation in the absence of altered pharyngeal pressure. The period of UOS-Pdrop was used as a proxy of UOS opening duration that is associated with a pressure decrease at the region of the UOS. Six healthy adults were seen 45 min daily for 2 weeks and for one follow-up session. During training, high-resolution manometry contour plots were provided for visual biofeedback. Participants were asked to maximally prolong the blue period on the monitor (period of UOS-Pdrop) without altering swallowing biomechanics. Performance was assessed prior to training start and following training. There was evidence within the first session for task-specific volitional prolongation of the period of UOS-Pdrop during swallowing with biofeedback; however, performance was not enhanced with further training. This may suggest that the amount to which the period of UOS-Pdrop may be prolonged is restricted in healthy individuals. The findings of this study indicate a potential of healthy adults to volitionally prolong UOS opening duration as measured by the period of pressure drop at the region of the UOS. Further research is indicated to evaluate purposeful pressure modulation intra-swallow in patient populations with UOS dysfunction to clarify if the specificity of behavioural treatment may be increased.
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Affiliation(s)
- Katharina Winiker
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand. .,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand. .,Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, Rorschach, 9400, Switzerland.
| | - Kristin Gozdzikowska
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand.,The Laura Fergusson Trust, 279 Ilam Road, Christchurch, 8053, New Zealand
| | - Esther Guiu Hernandez
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
| | - Seh Ling Kwong
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand.,Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Phoebe Macrae
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
| | - Maggie-Lee Huckabee
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
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Schar MS, Omari TI, Woods CM, Ferris LF, Doeltgen SH, Lushington K, Kontos A, Athanasiadis T, Cock C, Chai Coetzer CL, Eckert DJ, Ooi EH. Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea. J Clin Sleep Med 2021; 17:1793-1803. [PMID: 33904392 DOI: 10.5664/jcsm.9286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Dysphagia is a common but under-recognized complication of obstructive sleep apnea (OSA). However, the mechanisms remain poorly described. Accordingly, the aim of this study was to assess swallowing symptoms and use high-resolution pharyngeal manometry (HRPM) to quantify swallowing biomechanics in patients with moderate-severe OSA. METHODS Nineteen adults (4 female, mean age 46±26-68y) with moderate-severe OSA underwent HRPM testing with 5,10 & 20 ml volumes of thin and extremely thick liquids. Data were compared to 19 age- and sex-matched healthy controls (mean age 46±27-68y). Symptomatic dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ). Swallow metrics were analyzed using the online application swallowgateway.com. General linear mixed model analysis was performed to investigate potential differences between people with moderate-severe OSA and controls. Data presented are means (95% CI). RESULTS 26% (5/19) of the OSA group but none of the controls reported symptomatic dysphagia (SSQ>234). Compared to healthy controls, the OSA group had increased upper esophageal sphincter (UES) relaxation pressure (-2 [-1] vs. 2 [1]mmHg, F = 32.1, p <0.0001), reduced UES opening (6 vs. 5mS, F = 23.6, p<0.0001) and increased hypopharyngeal intrabolus pressure (2 [1] vs 7 [1]mmHg, F= 19.0, p <0.05). Additionally, upper pharyngeal pressures were higher, particularly at the velopharynx (88 [12] vs. 144 [12]mmHg.cm.s, F = 69.6, p<0.0001). CONCLUSIONS HRPM identified altered swallowing biomechanics in people with moderate-severe OSA, which is consistent with a subclinical presentation. Potential contributing mechanisms include UES dysfunction with associated upstream changes of increased hypopharyngeal distension pressure and velopharyngeal contractility.
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Affiliation(s)
- Mistyka S Schar
- Department of Speech Pathology & Audiology, Flinders Medical Centre.,Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Lara F Ferris
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Sebastian H Doeltgen
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Kurt Lushington
- Psychology, Justice & Society Academic Unit, University of South Australia
| | - Anna Kontos
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Department of Gastroenterology & Hepatology, Flinders Medical Centre
| | - Ching-Li Chai Coetzer
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Respiratory & Sleep Services, Flinders Medical Centre
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
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Fox MR, Sweis R, Yadlapati R, Pandolfino J, Hani A, Defilippi C, Jan T, Rommel N. Chicago classification version 4.0 © technical review: Update on standard high-resolution manometry protocol for the assessment of esophageal motility. Neurogastroenterol Motil 2021; 33:e14120. [PMID: 33729668 PMCID: PMC8268048 DOI: 10.1111/nmo.14120] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023]
Abstract
The Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). A key feature of CCv.4.0 is the more rigorous and expansive protocol that incorporates single wet swallows acquired in different positions (supine, upright) and provocative testing, including multiple rapid swallows and rapid drink challenge. Additionally, solid bolus swallows, solid test meal, and/or pharmacologic provocation can be used to identify clinically relevant motility disorders and other conditions (eg, rumination) that occur during and after meals. The acquisition and analysis for performing these tests and the evidence supporting their inclusion in the Chicago Classification protocol is detailed in this technical review. Provocative tests are designed to increase the diagnostic sensitivity and specificity of HRM studies for disorders of esophageal motility. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification, decrease the proportion of HRM studies that deliver inconclusive diagnoses and increase the number of patients with a clinically relevant diagnosis that can direct effective therapy. Another aim in establishing a standard manometry protocol for motility laboratories around the world is to facilitate procedural consistency, improve diagnostic reliability, and promote collaborative research.
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Affiliation(s)
- Mark R. Fox
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Rami Sweis
- Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Arlesheim, Switzerland
| | - Rena Yadlapati
- Center for Esophageal Diseases, Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - John Pandolfino
- Feinberg School of Medicine, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Albis Hani
- Pontificia Universidad Javeriana-Hospital San Ignacio, Bogota, Colombia
| | | | - Tack Jan
- University College London Hospital, London, UK
| | - Nathalie Rommel
- Translational Research in GastroIntestinal Disorders (TARGID, University of Leuven, Leuven, Belgium
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Suntrup-Krueger S, Muhle P, Kampe I, Egidi P, Ruck T, Lenze F, Jungheim M, Gminski R, Labeit B, Claus I, Warnecke T, Gross J, Dziewas R. Effect of Capsaicinoids on Neurophysiological, Biochemical, and Mechanical Parameters of Swallowing Function. Neurotherapeutics 2021; 18:1360-1370. [PMID: 33449304 PMCID: PMC8423940 DOI: 10.1007/s13311-020-00996-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/25/2023] Open
Abstract
Oropharyngeal dysphagia is prevalent in age-related neurological disorders presenting with impaired efficacy and safety of swallowing due to a loss of muscle force and sensory deficits. Stimulating the oropharynx with capsaicin that mediates Substance P release is an emerging pharmacological treatment option which needs further scientific evidence. Our aim was to comprehensively evaluate the effect of capsaicin on biochemical, neurophysiological, and biomechanical parameters of swallowing function. In a randomized study on healthy individuals, the impact of orally administered capsaicinoids at different dosages and application durations in comparison to non-carbonated water was evaluated. Time course and magnitude of salivary Substance P increase were monitored. Magnetoencephalography was used to detect cortical swallowing network alterations. Modifications in swallowing biomechanics were measured applying high-resolution pharyngeal manometry. Capsaicinoids at 10 μmol/L improved swallowing efficacy as seen by a significant increase of pharyngeal contractile integral and upper esophageal sphincter activation and relaxation times in manometry. Significant improvement of precision in a challenging swallow task accompanied by a reduction in swallowing-related submental electromyographic power was observed with capsaicinoids preconditioning at 10 μmol/L over 5 min, but not with continuous stimulation. The cortical activation pattern remained unchanged after any intervention. A significant increase of salivary Substance P was not detected with 10 μmol/L but with 50 μmol/L and lasted for 15 min after application. Capsaicinoids mediate dose-dependent Substance P release and positively alter swallowing biomechanics in healthy subjects. The results provide supportive evidence for the value of natural capsaicinoids to improve swallowing function.
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Affiliation(s)
- Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Isabella Kampe
- Pediatrics Department, St. Franziskus-Hospital Ahlen, Robert-Koch-Straße 55, 59227, Ahlen, Germany
| | - Paula Egidi
- Department of Anesthesiology and Intensive Care Medicine, Clemenshospital Münster, Duesbergweg 124, 48153, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Frank Lenze
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Richard Gminski
- Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Bendix Labeit
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
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Nomoto A, Ohno T, Kunieda K, Kanazawa H, Shigematsu T, Hojo K, Shimizu A, Minakuchi S, Fujishima I. Evaluation of a palatal lift prosthesis with a flexible lift in a lower cranial nerve palsy patient with dysphagia using high-resolution manometry: A case report. J Prosthodont Res 2021; 65:573-576. [PMID: 33612665 DOI: 10.2186/jpr.jpr_d_20_00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PATIENT Palatal lift prostheses (PLPs) are used for dysarthria caused by velopharyngeal incompetence (VPI) and improving hypernasal speech. In this case, we used a PLP with a flexible lift (f-PLP) in a patient with dysphagia associated with VPI due to right-sided cranial nerve injuries after a skull base surgery. We examined its efficacy in swallowing biomechanics and swallowing function using high-resolution manometry (HRM) and videofluoroscopic examination of swallowing (VF). The patient felt that it was easier to swallow with f-PLP. Furthermore, VF indicated that the pharyngeal residue with f-PLP was less than without it. HRM showed that velopharyngeal pressure and intrabolus pressure (IBP) with f-PLP were higher than those without it. Additionally, the upper esophageal sphincter (UES) relaxation time and UES nadir pressure on the patient's healthy left side compared to the right side improved with f-PLP. DISCUSSION We discovered two clinical outcomes. First, the f-PLP ensured velopharyngeal closure and an increase in the hypopharyngeal IBP, which potentially improved the UES opening on the healthy side. Second, the f-PLP improved pharyngeal clearance, and the patient felt that it was easier to swallow with the f-PLP. This implies that an f-PLP potentially exhibits a positive effect on swallowing. CONCLUSIONS In this case, the f-PLP contributed to improving the pharyngeal passage of a bolus. We suggest that f-PLPs can be used for patients with dysarthria and those with dysphagia with VPI.
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Affiliation(s)
- Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka.,Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka
| | - Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu
| | - Hideaki Kanazawa
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka
| | | | - Kyoko Hojo
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Mancopes R, Gandhi P, Smaoui S, Steele CM. Which Physiological Swallowing Parameters Change with Healthy Aging? OBM GERIATRICS 2021; 5:10.21926/obm.geriatr.2101153. [PMID: 34350402 PMCID: PMC8330408 DOI: 10.21926/obm.geriatr.2101153] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Research suggests there are age-related changes in swallowing that do not constitute impairment ("presbyphagia"). The goal of this study was to explore the influence of age on quantitative measures of healthy swallowing by controlling for the effects of sex and sip volume in order to determine the specific characteristics of presbyphagia. Videofluoroscopy recordings of thin liquid swallows from 76 healthy adults (38 male), aged 21-82 were analysed. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were made using the ASPEKT method. Hierarchical regression models were used to determine the effects of age, sex, and sip-volume on swallowing. There were no age-related changes in sip volume, number of swallows per bolus, frequency or severity of penetration-aspiration, duration of the hyoid-burst (HYB)-to-upper-esophageal-sphincter (UES) opening interval, time-to-laryngeal-vestibule-closure (LVC), peak hyoid position, hyoid speed, or pharyngeal residue. Significant changes seen with increasing age included: longer swallow reaction time, UES opening duration and LVC duration; larger pharyngeal area at rest and maximum constriction; and wider UES diameter. Male participants had larger sip volume and pharyngeal area at rest. Larger sip volumes were associated with multiple swallows per bolus and shorter hyoid-burst-to-UES opening intervals. These results help to define presbyphagic changes in swallowing that can be expected in healthy older adults up to 80 years of age, and distinguish them from changes that represent impairment. Certain parameters showed changes that were opposite in direction to changes that are usually considered to reflect impairment: longer UES opening, longer LVC duration and wider UES opening. These changes may reflect possible compensations for slower bolus transit. Further research is needed to determine the points along the age continuum where observed age-related changes in swallowing begin to emerge.
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Affiliation(s)
- Renata Mancopes
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute — Toronto Rehabilitation Institute — University Health Network, 550 University Avenue, 12 floor, Toronto, Ontario, Canada, M5G 2A2
| | - Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute — Toronto Rehabilitation Institute — University Health Network, 550 University Avenue, 12 floor, Toronto, Ontario, Canada, M5G 2A2
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto,500 University Avenue, Suite 160, Toronto, ON, Canada, M5G 1V7
| | - Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute — Toronto Rehabilitation Institute — University Health Network, 550 University Avenue, 12 floor, Toronto, Ontario, Canada, M5G 2A2
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto,500 University Avenue, Suite 160, Toronto, ON, Canada, M5G 1V7
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute — Toronto Rehabilitation Institute — University Health Network, 550 University Avenue, 12 floor, Toronto, Ontario, Canada, M5G 2A2
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto,500 University Avenue, Suite 160, Toronto, ON, Canada, M5G 1V7
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