Evaluation of manometric measures during tongue-hold swallows.

PURPOSE: Based on visual inspection, prior research documented increased movement of the posterior pharyngeal wall in healthy volunteers during tongue-hold swallows. This manometric study investigated the immediate effects of the tongue-hold maneuver on pharyngeal peak pressure generation, duration of pressure generation, and pressure slope measurements in healthy volunteers. METHOD: Pharyngeal pressures from 40 young, healthy individuals (mean age = 25.8 years, gender equally distributed) were recorded at 3 locations: oropharynx, hypopharynx, and upper esophageal sphincter (UES), during normal control and tongue-hold swallows. Measures of peak amplitude, duration, and slope of pressure generation were subjected to statistical analysis. RESULTS: Tongue-hold swallows produced lower pharyngeal peak pressure and shorter pharyngeal pressure durations compared to control swallows. Further, tongue-hold swallows produced lower UES relaxation pressures. Between sensors, peak pressure was lower and pressure slopes were steeper in the hypopharynx compared to the oropharynx. Several gender-specific differences were found for pharyngeal peak pressure, pressure duration, and pressure slopes. CONCLUSIONS: Reduced amplitude and duration of pharyngeal peak pressure is likely a result of decreased base of tongue retraction during tongue-hold swallows. Central clinical considerations and future research directions are discussed in this article.

The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants.

OBJECTIVE: To evaluate the effect of effortful swallow on pharyngeal manometric pressure measurements during saliva and water swallowing. DESIGN: Comparative analysis of pharyngeal pressure generation under 2 bolus and 2 task conditions. SETTING: Swallowing rehabilitation research laboratory. PARTICIPANTS: Healthy participants (N=40), sex equally represented, with a mean age of 25.8 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Manometric peak and nadir amplitude and duration measures at 3 locations in the pharynx. RESULTS: Significantly higher peak pressures were measured for saliva swallows compared with water swallows under both swallowing conditions at the proximal pharyngeal sensor only (P=.011). No significant differences were observed between the effortful versus noneffortful conditions at the proximal and midpharyngeal sensors; however, upper esophageal sphincter (UES) nadir pressures were significantly lower for effortful than noneffortful swallows (P=.034) with significantly lower pressure measurements in saliva effortful swallows (P=.008) compared with water effortful swallows. Saliva swallows resulted in significantly longer pressure durations than water swallows at the proximal (P=.003) and middle (P=.048) sensors. Pressure-generation duration was significantly longer in effortful versus noneffortful swallows for the middle sensor (P=.036) only. CONCLUSIONS: The results indicate that the effect of effortful swallow on pharyngeal peak pressure measurement is not altered by bolus type (saliva vs water). However, this is not the case for nadir pressure measurements in the UES, which were significantly lower in effortful saliva swallows than in effortful water swallows.

Clinical measurement of pharyngeal surface electromyography: exploratory research.

BACKGROUND: Dysphagia diagnosis is limited by our inability to evaluate the underlying neuromuscular pathology of swallowing. A novel approach using pharyngeal surface electromyography (PsEMG) has been reported in the literature. OBJECTIVE: Three exploratory projects were undertaken to provide data toward the validation of PsEMG as a clinical measure of pharyngeal physiology. The first evaluates laterality of electrode placement in the pharynx. The second and third evaluate PsEMG using a circumferential and unidirectional electrode, respectively, during swallowing maneuvers. METHODS: In experiment 1, a catheter housing 3 manometric sensors and 1 bipolar PsEMG electrode was randomly inserted in each nares of 10 participants. Moving jaw radiographs were taken, and the PsEMG electrode was measured in millimeters from midline. In experiments 2 and 3, the catheter was placed in 22 and 40 research participants, respectively. Waveform characteristics were collected during swallowing maneuvers. The 2 experiments differed by type of electrode (circumferential, unidirectional) and swallowing maneuver (noneffortful and effortful swallow; noneffortful, effortful, and tongue-hold swallow). RESULTS: Midline electrode placement occurred on 20% of trials with deviation of up to 14.7 mm on all other trials. Maneuver-specific differences in amplitude were not detected with PsEMG; unacceptable levels of intrasubject and intersubject variability were identified. Temporal relationships of PsEMG and pharyngeal manometric pressure appeared appropriate. The unidirectional electrode revealed a unique bimodal PsEMG pattern that may reflect sequential contraction of muscles of the posterior pharyngeal wall. CONCLUSIONS: The current PsEMG design and procedures do not validly measure pharyngeal muscle activity. Recommendations for improved methods are provided.

Effects of bolus volume on pharyngeal contact pressure during normal swallowing.

This cross-sectional study investigated the effect of bolus volume on contact pressure within the pharynx and upper esophageal sphincter (UES). Three solid-state manometric pressure sensors were placed transnasally into the pharynx and the proximal esophagus of 40 participants (gender equally represented and between the ages of 20 and 45 years). Participants completed five repetitions each of three swallowing conditions: 5-, 10-, and 20-ml water bolus swallows. Repeated-measures ANOVA revealed no significant differences in the amplitude of pharyngeal contact pressure between the three swallowing conditions (sensor 1: p = 0.627, sensor 2: p = 0.764). Similarly, for durational measures nonsignificant main effects were found at both sensor 1 (p = 0.436) and sensor 2 (p = 0.350). Significant differences were found in UES pressure between the three conditions of bolus swallows (p = 0.000), with negative pressure in the UES inversely proportionate to bolus volume. However, durational measures of UES relaxation pressure were not significantly different between all conditions (p = 0.473). This study demonstrates no significant pressure differences of amplitude and duration between swallowing conditions in the pharynx. At the level of the UES, smaller boluses generated greater negative pressure.