High-Resolution Manometry Evaluation of Pressures at the Pharyngo-upper Esophageal Area in Patients with Oropharyngeal Dysphagia Due to Vagal Paralysis

Abstract

The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus in patients with oropharyngeal dysphagia is still not entirely understood. High-resolution manometry (HRM) was recently added to the armamentarium for the study of this area. This study aims to describe HRM findings in patients with vagal paralysis. Sixteen patients (mean age 54 years, 69% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the UES and at the topography of the velopharynx and epiglottis were recorded. (1) UES relaxation is compromised in a minority of patients, (2) epiglottis pressure does not follow a specific pattern, (3) vellum is hypotonic in half of the patients, (4) dysphagia is related to a low pharyngeal pressure, not to a flow obstruction at the level of the UES, and (5) aspiration is related to low pressures at the level of the UES and epiglottis and higher pressures at the level of the vellum. Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed toward improvement in the oropharyngeal motility not at the UES.

High-resolution colonic manometry and its clinical application in patients with colonic dysmotility: A review

“…There has been no important change in the knowledge of colonic manometry since 1988. Pharyngeal/esophageal manometry is used by clinicians worldwide only to predict the subtypes of dysphagia and the treatment outcomes[65,66], for the following reasons: First, the esophagus is short and the manometric catheter can easily reach the stomach. Second, as patients can relatively control their esophageal movement, they can be told when to swallow.…”

Evaluation of upper oesophageal sphincter in unilateral vocal fold paralysis

“…Recently, Pinna et al . evaluated the swallowing pathologies of 16 patients with peripheral vagal paralysis, and compared their results with the data obtained in previous studies using a high-resolution manometer 20 . The residual pressure in the upper oesophageal sphincter was low in one-third of these patients and normal in the remaining two-thirds.…”

“…Patients with dysphagia had a lower epiglottal pressure and higher basal upper oesophageal sphincter pressure. The authors concluded that dysphagia was associated with decreased pharyngeal pressure, while aspiration was associated with decreased upper oesophageal sphincter pressures 20 …”

“…Pinna et al . evaluated patients with vagal paralysis using a high-resolution manometer; the epiglottal pressure was higher in half of the patients 20 . The epiglottal pressure was lower in patients with aspiration than in those without aspiration.…”

Pharyngeal motility in patients submitted to type I thyroplasty

“…Previous studies have shown that pharyngeal motility is affected in patients with UVFI. 7 , 8 Vocal fold medialization (VFM) seems to improve dysphagia symptoms in patients with UVFI. 5 Both injection medialization and Type I thyroplasty have been found to improve rates of penetration and aspiration on fluoroscopy 8 and bring better quality of life to dysphagic patients.…”