Three‐Dimensional Analysis of Pharyngeal High‐Resolution Manometry Data

Geng, Zhixian; Hoffman, Matthew R.; Jones, Corinne A.; McCulloch, Timothy M.; Jiang, Jack J.

doi:10.1002/lary.23987

Cited by 39 publications

(38 citation statements)

References 21 publications

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“…Earlier studies utilized fewer manometric sensors with only a single sector at each sensor location [13, 16]. The advent of 3-dimensional high resolution manometry may provide additional information to advance our understanding of the posterior and lateral pharyngeal movements during the tongue-hold maneuver [27]. Previous studies employed hands-on cursor measurements or studied participants who were reclined in a supine position [28].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography

et al. 2014

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The tongue-hold maneuver is a widely used clinical technique designed to increase posterior pharyngeal wall movement in individuals with dysphagia. It is hypothesized that the tongue-hold maneuver results in increased contraction of the superior pharyngeal constrictor. However, an electromyographic study of the pharynx and tongue during the tongue-hold is still needed to understand whether and how swallow muscle activity and pressure may change with this maneuver. We tested eight healthy young participants using simultaneous intramuscular electromyography with high-resolution manometry during three task conditions including (a) saliva swallow without maneuver, (b) saliva swallow with the tongue tip at the lip, and (c) saliva swallow during the tongue-hold maneuver. We tested the hypothesis that tongue and pharyngeal muscle activity would increase during the experimental tasks, but that pharyngeal pressure would remain relatively unchanged. We found that the pre-swallow magnitude of tongue, pharyngeal constrictor, and cricopharyngeus muscle activity increased. During the swallow, the magnitude and duration of tongue and pharyngeal constrictor muscle activity each increased. However, manometric pressures and durations remained unchanged. These results suggest that increased superior pharyngeal constrictor activity may serve to maintain relatively stable pharyngeal pressures in the absence of posterior tongue movement. Thus, the tongue-hold maneuver may be a relatively simple but robust example of how the medullary swallow center is equipped to dynamically coordinate actions between tongue and pharynx. Our findings emphasize the need for combined modality swallow assessment to include high-resolution manometry and intramuscular electromyography to evaluate the potential benefit of the tongue-hold maneuver for clinical populations.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography

et al. 2014

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“…Pressure in this region will rise from baseline inactivity before any other pressure rise in the pharynx and may display a bimodal pressure wave pattern (Figure 1). VP pressure events have been reported (18-20, 24) and are essential to define other regions of interest, but one that this study does not directly address.…”

Section: Methodsmentioning

confidence: 99%

“…Previous reports have combined pressures from the tongue base and hypopharynx in a single region (18, 19, 24). For the purposes of this study, we have separated these pressures into two regions, based on the shapes of the pressure waves.…”

Section: Methodsmentioning

confidence: 99%

Pharyngeal Pressure and Timing During Bolus Transit

2016

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Determining intrabolus pressure (IBP) at the upper esophageal sphincter (UES) and in the esophagus has given compelling evidence that IBP can be a predictor for swallowing dysfunction. Studies have looked most superiorly at the low hypopharynx region but there has been no inquiry into what IBP measures throughout the entire pharynx can tell us. We present a study to describe the pressures within and surrounding the moving bolus throughout the pharynx and into the UES. Simultaneous HRM and videofluoroscopy were performed in 10 healthy subjects swallowing ten 10 mL thin-liquid barium boluses. Three events surrounding bolus movement were tracked via videofluoroscopy, two additional events were found using manometric measures. As the bolus passes through the pharynx, low pressure is created at and below the head of the bolus. A modest pressure increase is seen as the bolus passes through the pharynx and finally, high pressure is observed at the bolus tail, followed by an even larger pressure generation of a clearance event. HRM allows for greater resolution in data collection in the pharynx and in this study, aided in identifying semi unique characteristics around the hypopharynx and the UES which are consistent with the complex anatomy of the regions and the transition of the UES from active closure to relaxed opening. In the future, additional studies designed to look at aged and diseased populations may lead to better understanding of disease etiology, and treatment options.

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“…A validated, semi-automatic program was used to calculate the pressure durations, maximum amplitudes, and pressure integrals (areas under the curve) in the velopharynx and mesopharynx, as well as pressure nadir durations, minimum opening pressure, and maximum closing pressure in the upper esophageal sphincter [46] (Figure 1). The velopharynx is a region of swallowing-related pressure that spans 2–3 cm and is related to the soft palate closing against the contracting pharyngeal walls [39].…”

Section: Methodsmentioning

confidence: 99%

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Jones

Ciucci

2016

JPD

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Background Parkinson disease (PD) has detrimental effects on swallowing function. Treatment options are largely behavioral; thus, patients would benefit from an earlier start to therapy. Early swallowing changes in PD are not well-known, so patients do not typically receive swallowing treatment until later in the progression of PD. Objective We used predictive modeling to determine what quantitative swallowing variables best differentiate individuals with early to mid-stage PD from healthy controls. Methods Participants included twenty-six individuals with early to mid-stage PD and 26 healthy, age- and sex-matched controls. Swallowing was evaluated by simultaneous high-resolution manometry and videofluoroscopy as well as the Sydney Swallow Questionnaire (SSQ). Binomial logistic regression was performed on 4 sets of data: 1) high-resolution manometry only; 2) videofluoroscopy only; 3) SSQ only; and 4) all data combined. Results A model from a combined data set had the highest accuracy in differentiating individuals with PD from controls. The model included maximum pressure in the velopharynx (soft palate), pressure variability in the velopharynx, and the SSQ item concerning difficulty with saliva swallowing. No significant models could be generated using the videofluoroscopy data. Conclusions Individuals with PD show quantitative changes in pressure generation and are able to self-assess aspects of swallowing function in the early and mid-stages of PD, even in the absence of swallowing changes seen on videofluoroscopy. A multimodal approach for the assessment of swallowing may be more accurate for determining subtle swallowing changes that occur in the early stages of PD.

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Three‐Dimensional Analysis of Pharyngeal High‐Resolution Manometry Data

Cited by 39 publications

References 21 publications

Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography

Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography

Pharyngeal Pressure and Timing During Bolus Transit

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

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