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

Abstract

There has been a recent shift towards proactive dysphagia intervention in motor neurone disease (MND) to maintain physiological reserve. Pharyngeal high-resolution manometry (PHRM) can quantify swallowing pathophysiology to inform and evaluate proactive dysphagia intervention. This study aims to explore the current use of PHRM as a dysphagia evaluation in adults with MND. A scoping review based on the Joanna Briggs Framework was completed. Four electronic databases (PubMed, EMBASE, CINAHL and Web of Science core) were searched (inception to March 2021) by two independent researchers. Data were analysed according to (i) PHRM protocol and analysis methods and the feasibility of same, (ii) swallow biomechanics data and (iii) dysphagia intervention effects as measured by PHRM. Six studies with 78 people with MND (PwMND) were included. There was considerable variation in PHRM protocol and analysis methods. Five studies reported a 100% completion rate and three studies reported no adverse events. Swallow biomechanics data were reported across all studies. The effects of sensory stimulation, increased bolus consistency, effortful swallow and cricopharyngeal myotomy were evaluated using PHRM with 20 PwMND across four studies with varying effects. Literature on the use of PHRM in PwMND is limited. Variability in PHRM methods restricts comparison of metrics. PHRM appears to be a feasible tool for PwMND. PHRM can provide novel swallow physiology data in PwMND and quantify discrete effects of compensatory and surgical dysphagia interventions not detectable by videofluoroscopy or FEES. Further research on the effects of proactive dysphagia intervention as measured by PHRM is required.

The Biomechanical Characteristics of Swallowing in Tracheostomized Patients with Aspiration following Acquired Brain Injury: A Cross-Sectional Study

“…TB was defined as the zone of swallow-related pressure change, with a high-pressure area midway between the VP and UES, with its center at the maximal pressure point and extending 2 cm proximal and distal to that point. The UES region was defined as the midpoint of stable high pressure just distal to the baseline low esophageal pressure zone [22,23]. Two investigators worked together in the data acquisition; if inconsistencies in the records happened, the measures were double-checked and proofread.…”

“…All subjects were required to be in a natural sitting position with their head in a neutral position, then underwent transnasal placement of the manometric catheter, and the catheter was fixed in place by taping it to the nostril. After a 10 min adaptation period, the subject was instructed to swallow 5 mL iohexol injection for a total of three swallows, and the data were analyzed using ManoView analysis software (Sierra Scientific Instruments, Los Angeles, CA, USA) [22,23].…”