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Ebersole BM, McMillan H, Hutcheson K. Evaluation and Management of Speech and Swallowing Issues in RFS. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Tsuyumu M, Hama T, Kato T, Kojima H. Adequate Number of Swallows for Pharyngeal Pressure Measurement of a Subject using High-resolution Manometry. Int Arch Otorhinolaryngol 2021; 25:e81-e87. [PMID: 33542756 PMCID: PMC7851372 DOI: 10.1055/s-0040-1702966] [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: 10/24/2019] [Accepted: 12/21/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction
The number of pressure measurements that need to be recorded using high-resolution manometry (HRM) for the accurate evaluation of pharyngeal function is not well established.
Objective
The purpose of this study is to clarify the number of swallows required to obtain an accurate pharyngeal manometric profile of a person.
Methods
Forty healthy adults performed a dry swallow and bolus swallows using 3-, 5-, or 10 ml of water and underwent measurements using the Starlet HRM system. Each subject underwent 10 swallows for each of the four bolus volume conditions.
Results
The mean of up to seven measurements of maximum pre-swallow upper esophageal sphincter pressure with 10 ml of swallow was close to the mean of up to eight measurements in 95% of the subjects. Similarly, the rate of change of the average for the eighth and ninth measurements and the rate of change for the average of the ninth and tenth measurements were less than 5%. When the other parameters were similarly measured up to the sixth measurement, no major change in the average value was observed even if more measurements were taken.
Conclusion
A minimum of six measurements are required, and seven swallows are sufficient for evaluating the pharyngeal manometric profile of a single person. This number of measurements can be a useful criterion when performing HRM measurements on individual subjects.
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Affiliation(s)
- Matsusato Tsuyumu
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Hama
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Takakuni Kato
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Rogus-Pulia NM, Jones CA, Forgues AL, Orne J, Macdonald CL, Connor NP, McCulloch TM. Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1550-1562. [PMID: 32569478 PMCID: PMC7893517 DOI: 10.1044/2020_ajslp-19-00134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/02/2019] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Purpose We assessed experienced clinicians' perceptions of benefits and drawbacks to the clinical adoption of pharyngeal high-resolution manometry (HRM). This article focuses on the professional and institutional factors that influence the clinical adoption of pharyngeal HRM by speech-language pathologists (SLPs). Method Two surveys (closed- and open-ended questions) and a series of focus groups were completed with SLP members of both the American Speech-Language-Hearing Association and the Dysphagia Research Society (DRS). Transcripts were inductively coded for emergent themes. Results Thirteen SLPs were recruited to attend focus group sessions at the American Speech-Language-Hearing Association. Eighty-seven SLPs responded to the DRS open-set response survey. Two additional focus groups of 11 SLPs were convened at the DRS meeting. Conventional content analysis revealed overall SLP enthusiasm for the clinical use of HRM, with some concerns about the technology adoption process. The following themes related to the professional and institutional factors influencing clinical adoption were identified: (a) scope of practice, (b) access, (c) clinical workflow, and (d) reimbursement. Conclusion These data serve to elucidate the most salient factors relating to the clinical adoption of pharyngeal HRM into routine speech-language pathology clinical practice. While enthusiasm exists, a variety of systems-level issues must be addressed to support this process.
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Affiliation(s)
- Nicole M. Rogus-Pulia
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
- Department of Medicine, University of Wisconsin–Madison
- Geriatric Research Education and Clinical Centers, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Corinne A. Jones
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Department of Neurology, The University of Texas at Austin
| | | | - Jason Orne
- Qualitative Health Research Consultants, LLC, Madison, WI
| | | | - Nadine P. Connor
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
| | - Timothy M. McCulloch
- Division of Otolaryngology, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
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Okawa J, Hori K, Fujiwara S, Uehara F, Shitara S, Kodama S, Ono T. Estimation of pharyngeal residue after swallowing by retronasal aroma. J Oral Rehabil 2020; 47:880-888. [PMID: 32270518 DOI: 10.1111/joor.12974] [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: 08/23/2019] [Revised: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharyngeal residue can trigger aspiration and choking after swallowing. Various studies to assess the amount of pharyngeal residue have been conducted; however, an easy and quantitative method is yet to be established. The aroma released from the pharyngeal residue is thought to be delivered from the pharynx to the nasal cavity via velopharynx by expiration, that is, retronasal pathway. OBJECTIVE This study verified that the amount of pharyngeal residue could be estimated by aroma intensity. METHODS Ten healthy adult subjects had tubes in from the oral cavity to the pharynx. Varying amounts of essence were dispensed into the pharynx through the tube either at rest or after swallowing the essence. Pharyngeal residue was simulated by retention essence in the pharynx without swallowing. An odour sensor was placed in the nostril, and the aroma intensity of the retained essence was measured over time. RESULTS The aroma intensity level flattened after a certain period of time had elapsed, and a significant correlation was found between the amount of essence dispensed and the flattened aroma intensity, both at rest and after swallowing. Furthermore, to estimate in a short period of time, changes in aroma intensity over time were estimated by fitting to a decay curve. The estimated intensity at convergence, calculated from the fitted curve from 80 to 120 seconds after swallowing, was significantly correlated to the measured intensity. CONCLUSION The amount of pharyngeal residue can be estimated in a short period of time by measuring the aroma intensity.
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Affiliation(s)
- Jumpei Okawa
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shigehiro Fujiwara
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fumiko Uehara
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoko Shitara
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shohei Kodama
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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A systematic review of current methodology of high resolution pharyngeal manometry with and without impedance. Eur Arch Otorhinolaryngol 2018; 276:631-645. [PMID: 30547253 DOI: 10.1007/s00405-018-5240-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/06/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE This systematic review appraises and summaries methodology documented in studies using high resolution pharyngeal manometry (HRM) with and without impedance technology (HRIM) in adult populations. METHODS Four electronic databases CINAHL, EMBASE, MEDLINE, and Cochrane Library were searched up to, and including March 2017. Studies reporting pharyngeal HRM/HRIM for swallowing and/or phonatory assessment, published in peer-reviewed journals in English, German, or Spanish were assessed for the inclusion criteria. Of the selected studies, methodological aspects of data acquisition and analysis were extracted. Publications were graded based on their level of evidence and quality of methodological aspects was assessed. RESULTS Sixty-two articles were identified eligible, from which 50 studies reported the use of HRM and 12 studies used HRIM. Of all included manuscripts, the majority utilized the ManoScan™ system (64.5%), a catheter diameter of 4.2 mm was most prevalently documented (30.6%). Most publications reported the application of topical anesthesia (53.2%). For data analysis in studies using HRM, software intrinsic to the recording system was reported most frequently (56%). A minority of the studies using HRM provided data about measurement reliability (10%). This is higher for studies using HRIM (50%). CONCLUSIONS Considerable methodological variability exists regarding data acquisition and analysis in published studies using HRM/HRIM. Lacking reports of methodology make study replications difficult and reduce the comparability across studies. More data regarding the impact of individual methodological aspects on study outcomes are further required for the development of methodological recommendations.
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Wu JF, Chung C, Tseng PH, Tsai IJ, Lin YC, Yang CH. Distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective esophageal motility disorder. Pediatr Res 2018; 84:849-853. [PMID: 30323346 DOI: 10.1038/s41390-018-0197-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/23/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We investigated the diagnostic utility of distal contractile integral (DCI) to esophageal impedance integral (EII) ratio (DCIIR) in high-resolution impedance manometry (HRIM) of ineffective esophageal motility (IEM) in children. METHODS We performed HRIM in 31 children with dysphagia, odynophagia, chronic vomiting, chest pain, or heartburn sensation. Based on the Chicago classification version 3.0, 20 subjects were diagnosed with IEM, and 11 subjects were normal. We analyzed the EII and DCIIR using MATLAB software. RESULTS The DCIIR calculated at the impedance cutoff at 1500 Ω (DCIIR1500) were significantly lower in IEM group than patients with normal motility (P = 0.007). Receiver operating characteristic (ROC) curve analysis showed that a DCIIR1500 < 0.009 mmHg/Ω best predicted IEM in children (P < 0.001). A DCIIR1500 < 0.008 mmHg/Ω is associated with significant body weight loss > 10% within 6 months in children. (P < 0.001). CONCLUSIONS The calculation of DCIIR1500 may assist the automatic analysis of bolus transit in HRIM study to diagnose IEM in children. An DCIIR1500 < 0.009 mmHg/Ω may assist in the diagnosis of IEM in children, and DCIIR1500 < 0.008 mmHg/Ω correlated with significant body weight loss. The calculation of DCIIR may serve as possible parameters for HRIM.
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Affiliation(s)
- Jia-Feng Wu
- Departments of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chieh Chung
- Graduate Institute of Electronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Ping-Huei Tseng
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Jung Tsai
- Departments of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Lin
- Graduate Institute of Electronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsiang Yang
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
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Lee TH, Lee JS. Safety of flexible endoscopic evaluation of swallowing examination in gastroenterological practice. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:148-154. [PMID: 30459134 DOI: 10.5152/tjg.2018.18279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS In South Korea, the flexible endoscopic evaluation of swallowing (FEES) has been increasingly performed by gastroenterologists. The principal concern was the safety of the FEES performed by gastroenterologists without any involvement of speech-language pathologists. We aimed to characterize the safety and tolerance of gastroenterologist-directed FEES examinations (GDFEES). MATERIALS AND METHODS We evaluated the GDFEES failures, safety profile (laryngospasm, epistaxis, vasovagal syncope, airway compromise, heart rate, blood pressure, and significant change in cardiovascular function), and discomfort level in patients undergoing GDFEES. These outcomes were also analyzed based on gender, age, and calendar period. RESULTS A total 303 examinations in 268 adult patients with dysphagia were performed during the study period. The GDFEES failures occurred in 5 patients (1.7%). The causes of failures were poor co-operation and insertion difficulty. There were no instances of laryngospasm or vasovagal syncope or significant cardiovascular changes in any of the examinations. Self-limiting epistaxis occurred in 22 examinations (7.3%). The discomfort ratings were as follows: 128 examinations (43.0%) rated the overall discomfort of the test as none, 150 (50.3%) as mild, 18 (6.0%) as moderate, and 2 (0.7%) as severe discomfort. The discomfort level was significantly different only between the first and second half periods (p <0.001), but it was related to neither gender nor age. CONCLUSION The GDFEES can be endorsed as an appropriate paradigm for clinical practice based on our study investigating its safety and tolerance.
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Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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Ryu JS, Park DH, Kang JY. Application and Interpretation of High-resolution Manometry for Pharyngeal Dysphagia. J Neurogastroenterol Motil 2015; 21:283-7. [PMID: 25843079 PMCID: PMC4398250 DOI: 10.5056/15009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/20/2022] Open
Abstract
The pharyngeal phase of swallowing is a complex event consisted with subsequent muscular contractions and pressure generation to move a bolus from the mouth to the esophagus. Recently, high-resolution impedance manometry (HRIM) was developed and used for the evaluation of pharyngeal dysphagia. Although HRIM provides precise pharyngeal pressure information, it has yet to be used as part of routine clinical practice for the assessment of dysphagia. The main reasons are thought to be that the test method and result interpretation are not easily applicable and standardized. The anatomical landmarks for HRIM parameters are velopharynx, tongue base, epiglottis, low pharynx, and upper esophageal sphincter. With HRIM, the pressure and timing data could be obtained at a precise anatomical structure. In the present review, we will review how to apply HRIM for the evaluation of pharyngeal dysphagia, including the interpretation of its parameters.
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Affiliation(s)
- Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Dong Hwi Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Jin Young Kang
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University, Seoul, Korea
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