Aim:This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods:Thirty three asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, mesohypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above-mentioned points of pressure measurement were also measured. Results:The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point in male were 141.1±73.5 (mmHg, mean ± standard deviation) and 162.7±94.9, 175.3±59.7 and 182.9±83.6, 172.7±73.8 and 236.1±78.9, and 10.0±1. Conclusion:The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies.

2b. Laryngoscope, 127:E371-E377, 2017.

Objectives:To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.Design:Parallel-arm, individual randomized controlled trial.Methods:Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.Results:Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001).Conclusion:The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.Clinical Trial.gov Identifier-UMIN000015567

Aim: This study aimed to investigate the effects of tongue-holding maneuver (THM) during swallowing using a novel high-resolution manometry (HRM) system. Materials and Methods: Thirty three asymptomatic Japanese adults were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures from the velopharynx to the upper esophagus at rest and during swallowing. The maximum values of the dry swallowing pressures at velopharynx, meso-hypopharynx, upper esophageal sphincter (UES), and distance from the nostril to each point of maximum values with and without THM were measured.Results: The maximum pressure was significantly greater when swallowing with THM than without THM only at UES (p= 0.0478), while there was no difference in the pressures between swallowing with or without THM at any other site. The distance from the nostril to the UES was significantly shorter (p= 0.0132) when swallowing with THM than without THM, while there was again no significant difference between swallowing with or without THM at any other site.Conclusion: These findings indicate that THM is likely to have a potential to facilitate compensatory swallowing power of the upper esophageal sphincter. Results: The maximum pressure was significantly greater when swallowing with THM than without THM only at UES (p= 0.0478), while there was no difference in the pressures between swallowing with or without THM at any other site. The distance from the nostril to the UES was significantly shorter (p= 0.0132) when swallowing with THM than without THM, while there was again no significant difference between swallowing with or without THM at any other site.Conclusion: These findings indicate that THM is likely to have a potential to facilitate compensatory swallowing power of the upper esophageal sphincter.

With regard to SP/AP amplitude ratio, 57.1% in definite cases of MD (group 1), 39.6% in probable cases of MD (group 2), and 50.0% in the cases who had transformed from probable MD to definite MD (group 3) showed abnormally high values, respectively. Abnormally high values were observed in 43.9%, 27.7%, and 30.0% in SP/AP area ratio in groups 1, 2, and 3, respectively, indicating that abnormal values were observed more frequently in the amplitude ratio than in the area ratio in all three groups.