Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Heslin, Niall; Regan, Julie

doi:10.1080/17549507.2021.1975817

Cited by 8 publications

(9 citation statements)

References 32 publications

(70 reference statements)

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“…Twelve of these 15 studies evaluated healthy participants (total n = 299) using pressure-based outcome measures (pressure peak or pressure duration) ( n = 11 studies) [ 14 , 15 , 26 – 31 , 34 , 35 , 37 ] or magnetic resonance imaging ( n = 1 study) [ 32 ]. Three studies evaluated immediate effects in patients with dysphagia [ 25 , 33 , 36 ]. Of these, one study investigated the effortful swallow in three patients with HNC [ 25 ] using low-resolution videomanometry.…”

Section: Resultsmentioning

confidence: 99%

“…All three of these patients presented with BOT-PPW contact pressures that were lower during normal control swallows than what had been reported for healthy controls. The second clinical study evaluated 15 patients with mixed etiology dysphagia using high-resolution manometry (HRM) ([ 36 ]. In both of these clinical studies, attempts were made to confirm that patients presented with instrumentally confirmed impairment of BOT-PPW approximation during control swallows either by comparison to published values in healthy controls [ 25 ] or comparison to median values within the patient group studied [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…The second clinical study evaluated 15 patients with mixed etiology dysphagia using high-resolution manometry (HRM) ([ 36 ]. In both of these clinical studies, attempts were made to confirm that patients presented with instrumentally confirmed impairment of BOT-PPW approximation during control swallows either by comparison to published values in healthy controls [ 25 ] or comparison to median values within the patient group studied [ 36 ]. The third clinical study described an effortful swallowing intervention as involving “increased lingual force” during swallowing [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review

et al. 2022

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Pharyngeal pressure generated by approximation of the base of tongue to the posterior pharyngeal wall (BOT-PPW approximation) is critical for efficient pharyngeal bolus passage and is a frequent goal of dysphagia management. This scoping review evaluated behavioral interventions available to improve BOT-PPW approximation. We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS, and ProQuest for studies that met the following criteria: (i) behavioral interventions targeting BOT-PPW approximation, which (ii) were assessed using BOT-PPW-specific outcome measures, and (iiia) performed over a period of time (Review Part 1) or (iiib) studied immediate effects (Review Part 2). Study quality was rated using the GRADE framework. Data were extracted and synthesized into dominant themes. Of the 150 studies originally identified, three examined long-term effects (two single cases studies of individuals with dysphagia, and a third study evaluating effortful swallowing in healthy individuals). BOT-PPW approximation only increased in the two single case studies. Twenty-one studies evaluating immediate effects were categorized as follows: (1) effortful swallowing, (2) Mendelsohn maneuver, (3) tongue-hold maneuver, (4) super supraglottic swallowing maneuver, and (5) non-swallowing exercises. Across all studies, varying levels of success in increasing BOT-PPW approximation were reported. Four of 21 immediate effects studies evaluated patients with demonstrated swallowing impairment, whereas 17 studies evaluated healthy adults. Quality assessment revealed low strength of the existing evidence base. The evidence base for rehabilitative interventions targeting BOT-PPW approximation is severely limited and translation is hindered by small sample sizes and methodological limitations. Further clinical research is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review

et al. 2022

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“…Effortful swallow, special maneuvers, volume, and viscosity have been shown to impact changes in PhCI values in adults 7,14,18‐20 . Due to practical and logistic issues, we did not evaluate these in young children.…”

Section: Discussionmentioning

confidence: 99%

Characterization of pharyngeal contractile integral using pharyngeal manometry in children

Damrongmanee,

El‐Chammas,

Santucci

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesPharyngeal 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).MethodsChildren 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.ResultsOf 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).ConclusionsPhCI 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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“…Current recommendations on P‐HRM‐I assessments of oro‐pharyngeal swallowing include guidance on deriving eight physiological measures that define pharyngeal contractile vigor as well as UES pressure relaxation and opening 8 . These parameters have already been helpful for characterizing the physiological and potential rehabilitative effects of swallowing exercise, 9,10 sensory stimulation, 11 and novel surgical interventions 12,13 . These measurements can complement routine clinical and instrumental swallowing assessments by adding understanding of the pathophysiology of dysphagia that may help guide patient management.…”

Section: Introductionmentioning

confidence: 99%

Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders

Omari

Cock

et al. 2022

Neurogastroenterology Motil

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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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Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Cited by 8 publications

References 32 publications

Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review

Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review

Characterization of pharyngeal contractile integral using pharyngeal manometry in children

Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders

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