Pharyngeal High-resolution Manometry Research Articles

High-resolution manometry and swallow outcomes after vocal fold injection medialization for unilateral vocal fold paralysis/paresis.

Injection medialization is performed to improve glottic closure, thereby airway protection. Overall objective to determine if unilateral injection medialization changes glottal area with concomitant adjustments in penetration/aspiration scale (PAS) scores and pharyngeal high-resolution manometry (HRM) parameters. Enrolled 17 adults with unilateral vocal fold paralysis/paresis and aspiration/penetration. Fiberoptic endoscopic evaluation of swallowing and pharyngeal HRM completed at (1) baseline (within 1 week before injection), (2) postinjection (within 1 week post injection), and (3) 1-month postinjection. Comparisons between time points for PAS scores, glottal area, pharyngeal pressure, and timing. No significant differences in normalized glottal area. No significant differences in PAS scores, for any consistency. Significantly increased rate of mesopharynx pressure rise and maximum pressure at 1 month postinjection (P = .01 and .02, respectively) compared to baseline. Significant decrease in mesopharynx integral from baseline to 1 week postoperative (P = .03). Findings suggest unilateral vocal fold injection medialization had limited effect on swallow function.

Safety and Tolerability of Pharyngeal High-Resolution Manometry.

Purpose Pharyngeal high-resolution manometry is an emerging practice for diagnosis of swallowing disorders in the upper aerodigestive tract. Advancement of a catheter through the upper esophageal sphincter may introduce safety considerations. There are no published studies of catheter placement complications, side effects, or tolerability. This study examines patient-reported side effects and tolerability of pharyngeal high-resolution manometry. Method Data were collected prospectively from 133 adult patients who underwent pharyngeal high-resolution manometry for the 1st time. Patients rated tolerability specific to "nose" and "throat" using a visual analog scale for 4 procedure time points: catheter passage, during the procedure, catheter removal, and after the procedure. Complications during catheter passage and removal were recorded. A telephone call was placed to the patient within 6 days to survey side effects experienced after the procedure. Results The patient sample was composed of 91 males and 42 females with a mean age of 66 years ( SD = 14.4). Tolerability scores for catheter passage showed no significant difference ( p = .7288) in the nose versus throat. Tolerability for females was significantly less ( p = .0144) than that for males. Participants with the shortest procedure duration showed greatest discomfort in the nose ( p = .0592) and throat ( p = .0286). Complications included gag response (14%), emesis (2%), and epistaxis (< 1%). Side effects included sore throat (16%), nose discomfort (16%), coughing (11 %), nosebleed (4%), and nausea/vomiting (4%). Conclusions High-resolution manometry appears to have high patient tolerability with low incidence of side effects. Rates of complications and side effects are similar to those reported for other transnasal procedures.

A systematic review of current methodology of high resolution pharyngeal manometry with and without impedance.

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. 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. 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 4.2mm 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%). 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.

High-resolution manometry: what about the pharynx?

High-resolution pharyngeal manometry (HRPM) is a well tolerated, catheter-based, method for recording the pressures and bolus flow generated by the pharyngeal muscles during swallowing. Despite a body of published evidence and a critical mass of investigators in the field, there is a lack of consensus surrounding what biomechanical phenomena to measure. The purpose of this review is to provide some insights into the information on swallowing physiology that can be gathered using HRPM. HRPM literature has focused on measuring biomechanical phenomena that may be relevant to measure in relation to dysphagia research. This review focuses on the measurement of pharyngeal luminal occlusive forces, intrabolus distension pressure, bolus presence and bolus flow timing as key features of pharyngeal swallowing that require measurement and allow for derivation of the Swallow Risk Index, a global measure of swallow function indicative of swallowing functional reserve. HRPM allows objective derivation of measures of swallow function that may have value for diagnosis and research in relation to swallowing disorders. HRPM has demonstrated clinical applicability in specific patient populations and offers unique advantages that compliment current assessment methods.

Reliability of an online analysis platform for pharyngeal high-resolution impedance manometry recordings

ABSTRACTObjectives: Pharyngeal high-resolution impedance manometry (HRIM) studies can be analysed by automated impedance manometry (AIM)-analysis to objectively asses swallowing. The aim of this study was to evaluate the reliability of a recently developed online AIM analysis portal.Methods: A database of 24 pharyngeal HRIM and videofluoroscopy studies (n = 18 oropharyngeal dysphagia patients and n = 6 controls; mean age 66, range 58–71 years) was established. Five observers of varying expertise analysed the database twice using AIMplot-online. Two experienced observers also performed the analysis using original AIMplot. Intra- and inter-rater reliability was determined by the intra-class correlation coefficient (ICC). Results from AIMplot and AIMplot-online and their relation to penetration aspiration scale (PAS) scores were compared.Results: The expert analysis confirmed that both analysis platforms differentiated patients from controls and, amongst patients, significant swallowing dysfunction. Intra- and inter-rater reliability were substantial to excellent; however, expertise and the inclusion of highly aberrant cases influenced the reliability of some measures.Conclusion: In conclusion, swallow function variables can be reliably derived using online software-based analysis and are altered in relation to increasing levels of swallowing dysfunction. By making the AIM analysis widely available via the Internet, the diagnostic potential of pharyngeal HRIM recordings can be fully and independently assessed.

SLP-Perceived Technical and Patient-Centered Factors Associated with Pharyngeal High-Resolution Manometry

High-resolution manometry (HRM) objectively measures swallowing-related pressures in the pharynx and esophagus. It has been used in many research applications, but it is unclear how HRM is perceived amongst speech-language pathologists (SLP) as it enters into clinical practice. The purpose of this study was to explore SLP perceptions of clinical HRM use. Based on qualitative data collected at four focus groups held at two national conferences and a survey based on open-ended questions, we found broad consensus among those queried regarding how HRM's objective and targeted data could enhance diagnosis and drive treatments. However, we found less consensus among SLPs regarding which patients may and may not benefit, as well as when in the clinical process HRM would best supplement existing technologies, showing a need for further research. These findings highlight how SLPs can be motivated to adopt new clinical technologies if they see a patient-centered benefit and underscore the need for continued SLP education on pharyngeal HRM.

Length Normalisation for Pharyngeal and Distal Contractile Integrals: Is It Necessary?

Introduction: High-resolution pharyngeal manometry (HRPM) is instrumental in evaluation of the intraluminal pressure in the pharynx, thus can be utilized in guiding therapy. The pharyngeal contractile integral (PhCI) is a HRPM metric assessing “vigor” of the pharyngeal contraction, and is analogous to the distal contractile integral (DCI) of the esophagus. Pharyngeal and esophageal length can vary from person to person and may confound PhCI and DCI measurements, so we decided to investigate this further. Methods: To compare normalized (nPhCI) and (nDCI) versus non-normalized PhCI and DCI using pharyngeal and esophageal length measurementsRetrospective study including 100 people underwent HRM excluding those with total absence of peristalsis. nDCI was calculated by dividing average DCI to their esophageal length which was defined by HRM as the distance between inferior border of UES to the upper of the LES. nPhCI was calculated by dividing average PhCI to its pharyngeal length. Pharyngeal length was measured radiographically from anterior superior edge of C1 vertebra to the anterior inferior edge of C5. Results: Results are summarized in table 1 and 2. nPhCI was tightly correlated with the original average PhCI, suggesting that pharyngeal length is fairly constant over the range of observed PhCI (r=0.95, p<0.001) (figure 1A). nDCI was also tightly correlated with the original average DCI value (r=0.99, p<0.001) (figure 1B). Conclusion: Data suggests that “normalization” for pharyngeal and esophageal lengths are not necessary when completing HRM. PhCI may a useful indicator of the severity of pharyngeal swallowing impairment. HRPM has the potential to be a valuable adjunct testing procedure in the evaluation and treatment of dysphagic individuals. 384_A Figure 1 No Caption available.384_B Figure 2 No Caption available.384_C Figure 3 No Caption available.

Correlates of Early Pharyngeal High-Resolution Manometry Adoption in Expert Speech-Language Pathologists.

Pharyngeal high-resolution manometry (HRM) is at a point of entry into speech-language pathologist (SLP) clinical practice. However, the demographic characteristics of SLPs who are early adopters of HRM are unclear; perspectives of early adopters may shape how the technology is received by the field at large. We hypothesized that younger SLPs, those working in outpatient settings, those with a strong knowledge base in HRM, and those with experience in other types of instrumentation are more likely to have interest in adopting HRM. We surveyed the population of board-certified SLPs (BCS-S; n = 262) with a 33% response rate (n = 78). Firth logistic regression was used to determine differences in those expressing interest in adopting HRM into future practice (n = 28) and those who did not (n = 45) from the analytic sample of 73 respondents. The best fitting model predicted that SLPs: (1) with training in more types of instrumentation; and (2) believing they could explain the HRM procedure to a patient were more likely to plan to adopt pharyngeal HRM into regular clinical practice. Experience with a variety of instrumentation techniques may encourage SLPs to use new forms of technology. Knowledge of early adopter demographics will allow for development of targeted trainings and determination of HRM implementation barriers. Identification of a clinician sub-group more likely to adopt other new technologies in the future may also be possible.

Effect of Body Position on Pharyngeal Swallowing Pressures Using High-Resolution Manometry.

The effect of body position and gravitational pull on the complex pressure-driven process of pharyngeal swallowing remains unknown. Using high-resolution manometry (HRM), this study aims to identify positional adaptations of pharyngeal physiology by evaluating swallowing pressure patterns in a series of inverted body positions. Ten healthy adults each underwent swallowing tasks with pharyngeal HRM at six body positions using an inversion table(0°[upright], 45°, 90°[supine], 110°, 135°, and 180°[fully inverted]). Repeated measures ANOVA was used to assess impact of position on pressure parameters, and pharyngeal-UES pressure gradients translate. Velopharyngeal pressures varied by position (P<0.001), with significantly higher pressures generated with inversion ≥90°, compared with upright and 45°. Change in position did not significantly affect common mesopharyngeal pressures or swallowing pressure durations. UES valving mechanisms were preserved during inversion, with subtle variations observed in integral pressures (P=0.011). Pharyngeal-UES pressure gradients changed with position (P<0.01), increasing with inversion>90° compared to upright and 45°. Mechanisms of deglutition may differ with position and relative direction of gravity, particularly when at>45° inclination. Increased palatal pressure is generated in the upside-down position to achieve nasopharyngeal closure and prevent regurgitation. While other classically measured pressures may not consistently differ with positioning, many individuals exhibit adaptations in pressure gradients when inverted, likely due to a combination of changes in pharyngeal driving force and UES opening mechanisms. Identification of these changes, relative to position, further builds on our understanding of the adaptability of the pharyngeal swallowing system.

Effect of topical nasal anesthetic on swallowing in healthy adults: A double-blind, high-resolution manometry study.

Topical nasal anesthetic (TNA) is used when evaluating pharyngeal swallowing with high-resolution manometry (HRM). It is unclear if desensitizing the nasal mucosa improves procedure tolerability or affects pharyngeal pressure. This study evaluated the effects of TNA on comfort and pharyngeal pressure using HRM. A double-blinded study was conducted with 20 healthy participants ( x¯ = 27 years). Participants performed five saliva and five 10-mL swallows during two exams with ManoScan HRM ESO catheter (Medtronic, Minneapolis, MN) randomized under placebo (nonanesthetic lubricant) and anesthetized (0.4 mL of 2% viscous lidocaine hydrochloride) conditions. Comfort was rated using a 100-mm visual analog scale (VAS). Pharyngeal HRM amplitude and timing were analyzed. VAS ratings were similar under placebo (mean = 38.4, standard deviation [SD] = 19.92) and TNA conditions (mean = 33.78, SD = 18.9), with no significant differences between placebo and anesthetized conditions (t[19] = 1.23, P = 0.23) or tolerability at first and second procedure (t[19] = 1.38, P = 0.18). Lower maximum and mean pharyngeal pressure were found for the TNA condition when compared to placebo (dry: maximum [-15.45 mmHg, standard error (SE) = 5.06 mmHg, P = 0.021]; mean [-5.22 mmHg, SE = 1.58 mmHg, P = 0.005]), and (liquid: maximum [-14.79 mmHg, SE = 5.01 mmHg, P = 0.010]; mean [-2.79 mmHg, SE = 1.99 mmHg, P = 0.008]). This double-blind, randomized study is the first to investigate effects of TNA on tolerability and pharyngeal pressure using HRM. Results indicate TNA offered no significant difference in procedure comfort while affecting the magnitude of pharyngeal swallowing. 4. Laryngoscope, 128:1335-1339, 2018.

Identification of swallowing disorders in early and mid-stage Parkinson's disease using pattern recognition of pharyngeal high-resolution manometry data.

Parkinson's disease (PD) can cause severe dysphagia, especially later in disease progression. Early identification of swallowing dysfunction may lead to earlier intervention. Pharyngeal high-resolution manometry (HRM) provides complementary information to videofluoroscopy, with advantages of being quantitative and objective. Artificial neural network (ANN) classification can examine non-linear relationships among multiple variables with relatively low bias. We evaluated if ANN techniques could differentiate between patients with PD and healthy controls. Simultaneous videofluoroscopy and pharyngeal HRM were performed on 31 patients with early to mid-stage PD and 31 age- and sex-matched controls during thin-liquid swallows of 2cc, 10cc and comfortable sip volume. We performed multilayer-perceptron analyses on only videofluoroscopic data, only HRM data or a combination of the two. We also evaluated variability-based parameters, representing variability in manometric parameters across multiple swallows. We hypothesized that patients with PD and controls would be classified with at least 80% accuracy, and that combined videofluoroscopic and HRM data would classify participants better than either alone. Classification rates were highest with all parameters considered. Maximum classification rate was 82.3±5.2%, recorded for 2cc swallows. Inclusion of variability-based parameters improved classification rates. Classification rates using only manometric parameters were similar to those using all parameters, and rates were substantially lower for the comfortable sip volumes. Results from these classifications highlight the differences between swallowing function in patients with early and mid-stage PD and healthy controls. Early identification of swallowing dysfunction is key to developing preventative swallowing treatments for those with PD.

High-resolution manometry of pharyngeal swallowing dynamics

To transport abolus from the mouth into the stomach, regular contraction of the pharyngeal muscles and a coordinated function of the upper esophageal sphincter (UES) are necessary. The muscle contraction generates intraluminal pressure, which pushes the bolus continuously forward. In contrast to imaging studies, manometric methods enable assessment of intraluminal pressure buildup and the function of the muscles involved. These methods were initially established for the esophagus and have been used increasingly in the pharynx for 7-8years. Pharyngeal high-resolution manometry (pHRM) allows pressure measurements in high spatial and temporal resolution, and assessment of pharyngeal swallowing dynamics. An overview is given of the implementation, evaluation, and interpretation of the pHRM data, as well as of the current state of research. PubMed and Scopus were searched for the keywords "high-resolution manometry" and "pharynx" or "upper esophageal sphincter". Original articles, reviews, and book chapters on the subject pHRM were included. Swallowing pressure conditions in the pharynx and the UES can be assessed by pHRM. The spatiotemporal pressure plot gives an overview of changes in pharyngeal motor function. Determination of swallowing parameters enables asophisticated evaluation of swallowing; acomparison with normal values permits delimitation of pathologies. Although several swallowing parameters still need to be further evaluated for clinical routine, apHRM study should nowadays always be carried out for acomprehensive evaluation of the swallowing process.

The use of high-resolution pharyngeal manometry as biofeedback in dysphagia therapy.

The use of high-resolution pharyngeal manometry as biofeedback in dysphagia therapy.

Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography.

To examine feasibility of a simultaneous high-resolution pharyngeal manometry (HRM) and electromyography (EMG) experimental paradigm to detect swallowing-related patterns of palatal, laryngeal, and pharyngeal muscle activity during expiratory training. Technical report. Simultaneous HRM, surface submental, and intramuscular EMG were acquired in two healthy participants during five tasks: 10-cc water swallow, maximum expiratory pressure (MEP) testing, and expiratory muscle strength training (EMST) at three pressure levels (sham, 50%, and 75% MEP). Experimental conditions were feasible. Velopharyngeal closing pressure, palate EMG activity, and pharyngeal EMG activity increased as expiratory load increased. In contrast, thyroarytenoid EMG activity was low during the expiratory task, consistent with glottic opening during exhalation. Submental EMG patterns were more variable during expiratory tasks. Intraluminal air pressures recorded with HRM were correlated with measured expiratory pressures and target valve-opening pressures of the EMST device. Results suggest that a simultaneous HRM/EMG/EMST paradigm may be used to detect previously unquantified swallowing-related muscle activity during EMST, particularly in the palate and pharynx. Our approach and initial findings will be helpful to guide future hypothesis-driven studies and may enable investigators to evaluate other muscle groups active during these tasks. Defining mechanisms of action is a critical next step toward refining therapeutic algorithms using EMST and other targeted treatments for populations with dysphagia and airway disorders. 4. Laryngoscope, 127:797-804, 2017.

Correlation Between Videofluoroscopic Swallowing Study and Esophageal Manometry Parameters in Assessing Oropharyngeal Dysphagia

Introduction: Oropharyngeal dysphagia is characterized by difficulty initiating a swallow and transferring food from the mouth to the pharynx and esophagus. There is limited data available evaluating the correlation between high resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) findings. We sought to evaluate correlations between upper esophageal manometric parameters and findings on VFSS and their relation with esophageal dysmotility. Methods: This was a retrospective chart review of 51 adult patients (pts) at Loyola University Medical Center who underwent both VFSS and HRM within1 yearbetween January 2012 and December 2015. Demographics included age, gender, and HRM final diagnosis. The UES and pharyngeal HRM parameters and VFSS variables were recorded. Statistical analysis was completed with Student's t-test, Wilcoxon rank sum test and Fisher's exact test. HRM parameters were compared to normal (nl)and abnormal (abnl)oral, pharyngeal, and esophageal phases to assess for a correlation. Final manometric diagnosis was compared tonl or abnl oral and pharyngeal phase to assess for correlation. Results: There was a significant difference in the pharyngeal mean peak pressure between pts with nl esophageal phase and abnl esophageal phase (p = 0.02). There was a significant difference in the pts with esophageal dysmotility found to have a nl pharyngeal phase (9/23 or 39%) compared to those with an abnl pharyngeal phase (p = 0.04). There were no significant correlations between UES dysfunction and oral or pharyngeal phase. Using pharyngeal mean peak pressure alone, an ROC curve was generated which found the probability of correctly determining whether a pt has nl or abnl esophageal phase to be 71%(95% CI: 0.54 - 0.88). A cut off pharyngeal mean peak pressure of 14.4 mmHg maximized sensitivity and specificity. (Fig 1-3).Figure 1Figure 2Figure 3Conclusion: Pts with abnl esophageal phase had a significantly higher pharyngeal mean peak pressure. Further, pts with esophageal dysmotility were more likely to have an abnormal pharyngeal phase.A stronger pharyngeal contraction may be required to push against increased resistance downstream. Pharyngeal peak pressure greater than 14.4 mmHg could prove useful in predicting an underlying motility disorder. These findings suggest that not all pts with UES dysfunction diagnosed on HRM will have abnl VFSS. Therefore, HRM and VFSS are complementary in assessing oropharyngeal dysphagia.

Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry.

Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a "functional" swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures. Six TL subjects without dysphagia and 6 controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects. The TL subjects had increased duration of velopharyngeal pressure (P = .012). Maximum mesopharyngeal pressure was lower versus controls (P = .003). Maximal and total pre-opening (P = .002, P = .002) and post-closure (P = .001, P = .002) UES pressures were lower. Maximum mesopharyngeal pressure (P = .032) decreased with increasing bolus volume. Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.

The Reliability of Pharyngeal High Resolution Manometry with Impedance for Derivation of Measures of Swallowing Function in Healthy Volunteers.

Purpose. We evaluated the intra- and interrater agreement and test-retest reliability of analyst derivation of swallow function variables based on repeated high resolution manometry with impedance measurements. Methods. Five subjects swallowed 10 × 10 mL saline on two occasions one week apart producing a database of 100 swallows. Swallows were repeat-analysed by six observers using software. Swallow variables were indicative of contractility, intrabolus pressure, and flow timing. Results. The average intraclass correlation coefficients (ICC) for intra- and interrater comparisons of all variable means showed substantial to excellent agreement (intrarater ICC 0.85–1.00; mean interrater ICC 0.77–1.00). Test-retest results were less reliable. ICC for test-retest comparisons ranged from slight to excellent depending on the class of variable. Contractility variables differed most in terms of test-retest reliability. Amongst contractility variables, UES basal pressure showed excellent test-retest agreement (mean ICC 0.94), measures of UES postrelaxation contractile pressure showed moderate to substantial test-retest agreement (mean Interrater ICC 0.47–0.67), and test-retest agreement of pharyngeal contractile pressure ranged from slight to substantial (mean Interrater ICC 0.15–0.61). Conclusions. Test-retest reliability of HRIM measures depends on the class of variable. Measures of bolus distension pressure and flow timing appear to be more test-retest reliable than measures of contractility.

Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction.

Assessment of upper esophageal sphincter (UES) motility is challenging, as functionally, UES relaxation and opening are distinct. We studied novel parameters, UES admittance (inverse of nadir impedance), and 0.2-s integrated relaxation pressure (IRP), in patients with cricopharyngeal bar (CPB) and motor neuron disease (MND), as predictors of UES dysfunction. Sixty-six healthy subjects (n = 50 controls 20-80 years; n = 16 elderly >80 years), 11 patients with CPB (51-83 years) and 16 with MND (58-91 years) were studied using pharyngeal high-resolution impedance manometry. Subjects received 5 × 5 mL liquid (L) and viscous (V) boluses. Admittance and IRP were compared by age and between groups. A p < 0.05 was considered significant. In healthy subjects, admittance was reduced (L: p = 0.005 and V: p = 0.04) and the IRP higher with liquids (p = 0.02) in older age. Admittance was reduced in MND compared to both healthy groups (Young: p < 0.0001 for both, Elderly L: p < 0.0001 and V: p = 0.009) and CPB with liquid (p = 0.001). Only liquid showed a higher IRP in MND patients compared to controls (p = 0.03), but was similar to healthy elderly and CPB patients. Only admittance differentiated younger controls from CPB (L: p = 0.0002 and V: p < 0.0001), with no differences in either parameter between CPB and elderly subjects. The effects of aging and pathology were better discriminated by UES maximum admittance, demonstrating greater statistical confidence across bolus consistencies as compared to 0.2-s IRP. Maximum admittance may be a clinically useful determinate of UES dysfunction.

Tu1999 Feasibility Model of Concurrent Pharyngeal Provocation and High Resolution Manometry (HRM) in Human Neonates

Tu1999 Feasibility Model of Concurrent Pharyngeal Provocation and High Resolution Manometry (HRM) in Human Neonates

Tu1190 Prevalence of Esophageal Symptoms by ROME III Criteria in Asia and Their Association With Other Functional Gastrointestinal Disorders

Introduction: Pharyngeal High Resolution Manometry (HRM) has been increasingly used in research studies. The utility of this technique for clinical purposes requires a better understanding of the effects of variables on the recorded pressure signature. Some of these variables such as neck position and volume of swallowed material may not have appreciable effect on esophageal pressure measurements but could affect the pharynx significantly. Therefore, our AIM was to determine the effect of the bolus volume, several neck positions, and posture on the pharyngeal and Upper Esophageal Sphincter (UES)pressure phenomenon using HRM technique. Methods: We studied 16 healthy young volunteers (8 F, age 20-30 years) with HRM in four neck positions (neck neutral, neck 15 extension, neck 30° and 45° flexion) and 2 body postures (sitting and supine), four volumes (dry and 5 ml, 10 ml and 20 ml). Each swallow volume was repeated three times. We measured amplitude (mmHg) duration (s) and velocity (cm/s). Results: A total of 1536 swallows were evaluated. Pharyngeal pressure phenomenon exhibited larger duration in the proximal pharynx compared to distal, while they exhibited higher amplitude in the distal pharynx compared to the proximal pharynx but not velopharyngeal region(P7-P6) (figure 1a and 1b). These parameters were not affected by posture, neck position or volume of swallowed liquid. Intrabolus hypopharyngeal pressure (IBP) increased with increased swallowed volume significantly (P,0.05). There was no effect by posture or neck position on the IBP. Resting UES pressure was not affected by the posture, however it showed significant change due to neck position P,0.05 (Table) ConclusionDuring pharyngeal HRM, neck position or posture has no appreciable effect on recorded pharyngeal peristalsis; however it affects the UES pressure significantly. This effect needs to be considered during pharyngeal HRM. Table. Effect of neck position on pharyngo-UES HRM variables