Pharyngeal Pressure Variability During Volitional Swallowing Maneuvers

Abstract

Purpose: Within-individual pharyngeal swallowing pressure variability differs among pharyngeal regions in healthy individuals and increases with age. It remains unknown if pharyngeal pressure variability is impacted by volitional swallowing tasks. We hypothesized that pressure variability would increase during volitional swallowing maneuvers and differ among pharyngeal regions depending on the type of swallowing task being performed. Method: Pharyngeal high-resolution manometry was used to record swallowing pressure data from 156 healthy participants during liquid (5 cc) or saliva swallows, and during volitional swallowing tasks including effortful swallow, Mendelsohn maneuver, Masako maneuver, or during postural adjustments. The coefficient of variation was used to determine pressure variability of velopharynx, tongue base, hypopharynx, and upper esophageal sphincter regions. Repeated-measures analysis of variance was used on log-transformed data to examine effects of pharyngeal region and swallowing tasks on swallow-to-swallow variability. Results: There was a significant main effect of task with greater pressure variability for the effortful swallow ( p = .002), Mendelsohn maneuver ( p < .001), Masako maneuver ( p = .002), and the head turn ( p = .006) compared with normal effort swallowing. There was also a significant main effect of region ( p < .01). In general, swallowing pressure variability was lower for the tongue base and upper esophageal sphincter regions than the hypopharynx. There was no significant interaction of task and region (effortful, p = .182; Mendelsohn, p = .365; Masako, p = .885; chin tuck, p = .840; head turn, p = .059; and inverted, p = .773). Conclusions: Pharyngeal swallowing pressure variability increases in healthy individuals during volitional swallowing tasks. Less stable swallow patterns may result when tasks are less automatic and greater in complexity. These findings may have relevance to swallowing motor control integrity in healthy aging and individuals with neurogenic dysphagia.

Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review

“…This review reveals that studies using PHRM in PwMND are no exception to these gaps or discrepancies. The combination of the variation in PHRM protocol and analysis methods across research centres and PHRM pressure variability with age, volitional swallow tasks and pharyngeal region previously described [ 13 , 14 ] have the potential to markedly impact on clinical judgement in PHRM evaluation and warrant considerable caution until our understanding of PHRM best practice evolves. Pressure variability is of particular relevance to PwMND as this population is likely to present with impaired swallow motor control and an unpredictable swallow performance [ 14 ].…”

“…Whilst PHRM provides novel data on swallow physiology, within-subject pressure variability has been reported during volitional swallowing tasks [13]. The effect of age, pharyngeal region and volume on pharyngeal swallow pressure variability has also been established [14].…”

“…PHRM can clarify the biomechanical foundations of dysphagia that cannot be understood from visualisation alone, which would contribute to an enhanced, more targeted intervention plan for the PwMND. Whilst PHRM provides novel data on swallow physiology, within-subject pressure variability has been reported during volitional swallowing tasks [ 13 ]. The effect of age, pharyngeal region and volume on pharyngeal swallow pressure variability has also been established [ 14 ].…”

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

“…All other metrics unchanged Low Lenius, [ 33 ] Quasi-experimental ES (described as increased lingual force during swallow) v Normal LRVM Peak pressure HNC ( n = 20) (range = 3–179 months post radion therapy) 41–80 years (62) Increased lingual effort increased peak pharyngeal pressure Low Doeltgen, [ 34 ] Quasi-experimental ES v Normal HRM VCI Healthy ( n = 12) 21–48 years (28.6) VCI increased during ES Low Jones, [ 35 ] Quasi-experimental ES v Normal HRM Peak pressure at velopharynx, tongue base, and hypopharynx Healthy ( n = 9) 21–69 years (42) ES increased peak pressure at all three levels Low Heslin, [ 36 ] Quasi-experimental ES v normal HRM Peak pressure mixed etiology dysphagia ( n = 15) 45–86 years (63) ES increased upper pharyngeal pressure Very low Teplansky, [ 37 ] Quasi-experimental ES v normal HRM Peak pressure variability at velopharynx, tongue base, and hypopharynx Healthy ( n = 51) not stated (31.5) ES increased variability of peak pressure at all three levels Low Intervention 2—Mendelsohn Maneuver …”

“…TH increased vallecular residue Low Lazarus, [ 25 ] Quasi-experimental TH v Normal LRVM Peak pressure on manometry and contact duration on VFSS HNC ( n = 3) 65 years, 73 years, 72 years TH increased pharyngeal peak pressure and increased contact duration on VFSS and nominally decreased upper pharyngeal residue Low Doeltgen, [ 41 ] Quasi-experimental TH v Normal LRM Peak pressure, pressure duration Healthy ( n = 40) 20–45 years (not stated) TH swallows decreased peak pharyngeal pressure; TH swallows did not change pressure duration Low Doeltgen, [ 42 ] Quasi-experimental TH v Normal LRM Peak pressure, pressure duration Healthy ( n = 68) Y ( n = 34) O ( n = 34) Y 18–40 years (26.8) O 60–84 years (72.6) In both age groups, TH decreased peak pharyngeal pressure, but did not change pressure duration Low Hammer, [ 43 ] Quasi-experimental TH v Normal (1. tongue at lips; 2. tongue-hold maneuver) EMG, HRM SPC EMG, peak pressure Healthy ( n = 8) 20–27 years (not stated) Both maneuvers increased EMG of SPC before and during the swallow; TH prolonged SPC EMG. Neither maneuver affected peak pharyngeal pressure Low Teplansky, [ 37 ] Quasi-experimental TH v normal HRM Peak pressure variability at velopharynx, tongue base, and hypopharynx Healthy...…”