Objective High-resolution manometry (HRM) represents a critical advance in the quantification of swallow-related pressure events in the pharynx. Previous analyses of the pressures measured by HRM, though, have been largely two-dimensional, focusing on a single sensor in a given region. We present a method a three-dimensional approach which combines information from adjacent sensors in a region. Two- and three-dimensional approaches were compared for their ability to classify data correctly as normal or disordered. Study Design Case series evaluating new method of data analysis. Methods 1,324 total swallows from 16 normal subjects and 61 subjects with dysphagia were included. Two-dimensional single sensor integrals of the area under the curves created by rises in pressure in the velopharynx, tongue base, and UES were calculated. Three-dimensional multi-sensor integrals of the volume under all curves corresponding to the same regions were also computed. The two sets of measurements were compared for their ability to classify data correctly as normal or disordered using an artificial neural network (ANN). Results Three-dimensional parameters yielded a maximal classification accuracy of 86.71±1.47%, while two-dimensional parameters achieved a maximum accuracy of 83.36±1.42%. When combining two- and three-dimensional parameters with all other variables, including three-dimensional parameters yielded a classification accuracy of 96.99±0.51%, and including 2-dimensional parameters yielded a classification accuracy of 96.32±1.05%. Conclusion Three-dimensional analysis led to improved classification of swallows based on pharyngeal HRM. Artificial neural network performance with both two-dimensional and three-dimensional analyses was effective, classifying a large percentage of swallows correctly, thus demonstrating its potential clinical utility.
Objective To determine if pattern recognition techniques applied to high-resolution manometry (HRM) spatiotemporal plots of the pharyngeal swallow can identify features of disordered swallowing reported on the Modified Barium Swallow Impairment Profile (MBSImP). Study Design Case series evaluating new method of data analysis. Setting University hospital. Subjects and Methods Simultaneous HRM and videofluoroscopy was performed on 30 subjects (335 swallows) with dysphagia. Videofluoroscopic studies were scored according to the MBSImP guidelines while HRM plots were analyzed using a novel program. Pattern recognition using a multilayer perceptron artificial neural network (ANN) was performed to determine if seven pharyngeal components of the MBSImP as well as penetration/aspiration status could be identified from the HRM plot alone. Receiver operating characteristic (ROC) analysis was also performed. Results MBSImP parameters were identified correctly as normal or disordered at an average rate of approximately 91% (area under the ROC curve ranged from 0.902 to 0.981). Classifications incorporating two MBSImP parameters resulted in classification accuracies over 93% (area under the ROC curve ranged from 0.963 to 0.989). Conclusion Pattern recognition coupled with multiparameter quantitative analysis of HRM spatiotemporal plots can be used to identify swallowing abnormalities which are currently assessed using videofluoroscopy. The ability to provide quantitative, functional data at the bedside while avoiding radiation exposure make HRM an appealing tool to supplement and, at times, replace traditional videofluoroscopic studies.
Purpose The purpose of this study was to investigate inter- and intra-rater reliability among expert users, novice users, and speech-language pathologists with a semi-automated high-resolution manometry analysis program. We hypothesized that all users would have high intra-rater reliability and high inter-rater reliability. Method Three expert users, 15 novice users, and 5 speech-language pathologists participated in this study. Following a 20-minute training session, users analyzed 30 high-resolution manometry plots using an automated analysis program. Output parameters included two- and three-dimensional pressure integrals over 5 anatomical regions of interest. Intraclass correlations were used to examine inter- and intra-rater reliability. Analysis of variance was also performed to determine any differences in mean output parameter values. Results Within-group inter-rater reliability ranged from 0.54-0.99 and inter-group reliability ranged from 0.92-0.99. Intra-rater reliability ranged from 0.67-1.00 across all groups. There were no significant differences of output parameters between groups. Conclusion The high reliability observed after a short training session demonstrate that individuals with little to no prior knowledge of swallowing physiology can perform at a similar level as those with expertise. Given the quickness and ease of training in the use of this program, it has the potential for research and clinical utility.
Objectives/Hypothesis To investigate the use of the Video-Based Phonomicrosurgery Instrument Tracking System to collect instrument position data during simulated phonomicrosurgery and calculate motion metrics using these data. We used this system to determine if novice subject motion metrics improved over 1 week of training. Study Design Prospective cohort study. Methods Ten subjects performed simulated surgical tasks once per day for 5 days. Instrument position data were collected and used to compute motion metrics (path length, depth perception, and motion smoothness). Data were analyzed to determine if motion metrics improved with practice time. Task outcome was also determined each day, and relationships between task outcome and motion metrics were used to evaluate the validity of motion metrics as indicators of surgical performance. Results Significant decreases over time were observed for path length (P <.001), depth perception (P <.001), and task outcome (P <.001). No significant change was observed for motion smoothness. Significant relationships were observed between task outcome and path length (P <.001), depth perception (P <.001), and motion smoothness (P <.001). Conclusions Our system can estimate instrument trajectory and provide quantitative descriptions of surgical performance. It may be useful for evaluating phonomicrosurgery performance. Path length and depth perception may be particularly useful indicators.
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