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Damrongmanee A, El-Chammas K, Santucci N, Fei L, Kaul A. Characterization of pharyngeal contractile integral using pharyngeal manometry in children. J Pediatr Gastroenterol Nutr 2024; 78:783-789. [PMID: 38314945 PMCID: PMC11111290 DOI: 10.1002/jpn3.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Pharyngeal contractile integral (PhCI) is the product of mean pharyngeal contractile amplitude, length, and duration, and provides a single metric for the vigor of entire pharyngeal contraction. A major limitation in children is lack of characterization of PhCI on high-resolution pharyngeal manometry. We aimed to determine and compare the values of PhCI in children with the abnormal and normal videofluoroscopic study of swallow (VFSS). METHODS Children who underwent high-resolution pharyngeal and esophageal manometry (HRPM/HREM), as well as VFSS, were divided into two groups; "normal VFSS" and "abnormal VFSS" groups. PhCI was calculated from the pharyngo-esophageal manometry analysis software (MMS, v9.5, Laborie Medical Technologies), and compared in these two groups. RESULTS Of 67 children, 9 had abnormal VFSS (mean age 64 ± 50 months; 66.7% males), while 58 had normal VFSS (mean age 123 ± 55 months; 47% males). The mean PhCI in abnormal and normal VFSS groups was 82.00 ± 51.90 and 147.28 ± 53.89 mmHg.s.cm, respectively (p = 0.001). Subjects with abnormal VFSS were significantly younger than those with normal VFSS (p = 0.003). However, after adjusting for the VFSS result, age was no longer related to PhCI (p = 0.364). In subgroup analysis of children presenting with dysphagia, the mean PhCI in abnormal (9 subjects) and normal (36 subjects) VFSS groups was 82.00 ± 51.90 and 141.86 ± 50.39 mmHg.s.cm, respectively (p = 0.003). CONCLUSIONS PhCI was significantly lower in children with abnormal VFSS than in those with normal VFSS. We did not find a significant impact of age on PhCI in our pediatric populations.
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Affiliation(s)
- Alisara Damrongmanee
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Khalil El-Chammas
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Neha Santucci
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lin Fei
- Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Ohio, USA
| | - Ajay Kaul
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, Alıcı R, Demir N, Oğuz B, Düger T. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One 2024; 19:e0299845. [PMID: 38527058 PMCID: PMC10962842 DOI: 10.1371/journal.pone.0299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).
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Affiliation(s)
- Ömer Faruk Yaşaroğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Emre Cengiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Rabia Alıcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Hospitals, Ankara, Türkiye
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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Walters RK, Gudipudi R, Gordis T, Davidson K, Nguyen SA, O'Rourke AK. A Systematic Review of Pharyngeal High-Resolution Manometry Normative Data. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1059-1068. [PMID: 38127890 DOI: 10.1044/2023_ajslp-23-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values. METHOD A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure. RESULTS Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters. CONCLUSIONS Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24843753.
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Affiliation(s)
- Rameen K Walters
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Rachana Gudipudi
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Tamar Gordis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Kate Davidson
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
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Ohashi M, Aoyagi Y, Ito S, Kagaya H, Hirata M, Nakata S. Comparison of electromyography, sound, bioimpedance, and high-resolution manometry for differentiating swallowing and vocalization events. Med Eng Phys 2023; 115:103980. [PMID: 37120175 DOI: 10.1016/j.medengphy.2023.103980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/09/2023] [Accepted: 04/09/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are no comparative studies in which these waveforms were recorded simultaneously. We assessed the accuracy and efficiency of high-resolution manometry (HRM) topography, EMG, sound, and bioimpedance waveforms, for identifying swallowing events. METHODS Six participants randomly performed saliva swallow or vocalization of "ah" 62 times. Pharyngeal pressure data were obtained using an HRM catheter. EMG, sound, and bioimpedance data were recorded using surface devices on the neck. Six examiners independently judged whether the four measurement tools indicated a saliva swallow or vocalization. Statistical analyses included the Cochrane's Q test with Bonferroni correction and the Fleiss' kappa coefficient. RESULTS Classification accuracy was significantly different between the four measurement methods (P < 0.001). The highest classification accuracy was for HRM topography (>99%), followed by sound and bioimpedance waveforms (98%), then EMG waveform (97%). The Fleiss' kappa value was highest for HRM topography, followed by bioimpedance, sound, and then EMG waveforms. Classification accuracy of the EMG waveform showed the greatest difference between certified otorhinolaryngologists (experienced examiners) and non-physicians (naive examiners). CONCLUSION HRM, EMG, sound, and bioimpedance have fairly reliable discrimination capabilities for swallowing and non-swallowing events. User experience with EMG may increase identification and interrater reliability. Non-invasive sound, bioimpedance, and EMG are potential methods for counting swallowing events in screening for dysphagia, although further study is needed.
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Affiliation(s)
- Miho Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
| | - Satoshi Ito
- Department of Otorhinolaryngology and Sleep Medicine, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masatoshi Hirata
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology and Sleep Medicine, School of Medicine, Fujita Health University, Nagoya, Japan
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Mialland A, Atallah I, Bonvilain A. Toward a robust swallowing detection for an implantable active artificial larynx: a survey. Med Biol Eng Comput 2023; 61:1299-1327. [PMID: 36792845 DOI: 10.1007/s11517-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.
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Affiliation(s)
- Adrien Mialland
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France.
| | - Ihab Atallah
- Institute of Engineering and Management Univ. Grenoble Alpes, Otorhinolaryngology, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Agnès Bonvilain
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France
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Borges TGV, Muniz CR, Ferreira FR, Brendim MP, Muxfeldt ES. Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2023; 280:443-453. [PMID: 36098863 PMCID: PMC9469056 DOI: 10.1007/s00405-022-07612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate (i) the outcome of swallowing therapy program on the rehabilitation of oropharyngeal dysphagia in resistant hypertensive patients with obstructive sleep apnea (OSA) and (ii) the association between the clinical and anthropometric characteristics of these individuals and this outcome. METHODS This was a prospective interventional study in which resistant hypertensives diagnosed with OSA by polysomnography and dysphagia by fiberoptic endoscopic evaluation of swallowing (FESS) participated. All participants underwent a FEES and assessment of the risk of dysphagia (Eating Assessment Tool, EAT-10) and swallowing-related quality of life (Swal-QoL) before and after the intervention. The therapeutic program was performed daily by the participants, with weekly speech-therapist supervision for eight weeks, including the following strategies: Masako, chin tuck against resistance, and expiratory muscle training. RESULTS A total of 26 (78.8%) of the participants exhibited improvement in the degree of dysphagia in the intervention outcome. After the intervention, there was a statistically significant improvement in the level of penetration-aspiration (p = 0.007), the degree of pharyngeal residue (p = 0.001), the site of onset of the pharyngeal phase (p = 0.001), and the severity of dysphagia (p = 0.001) compared to before intervention. The EAT-10 score was 2 (0-6) before and 0 (0-3) after intervention (p = 0.023). Swal-QoL had a score on the symptom frequency domain of 92.8 (75-100) before and 98.2 (87.5-100) after intervention (p = 0.002). CONCLUSIONS Resistant hypertensive patients with OSA showed improved swallowing performance after swallowing therapy program.
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Affiliation(s)
- Thalyta Georgia Vieira Borges
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Carla Rocha Muniz
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Flavia Rodrigues Ferreira
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Mariana Pinheiro Brendim
- Speech-Language Pathology Department, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 4º andar - Speech-Language Pathology Clinic, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha do Fundão, Rio de Janeiro, 21941-590 Brazil
| | - Elizabeth Silaid Muxfeldt
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
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Omari T, Cock C, Wu P, Szczesniak MM, Schar M, Tack J, Rommel N. Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders. Neurogastroenterol Motil 2023; 35:e14461. [PMID: 36121685 DOI: 10.1111/nmo.14461] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oro-pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high-resolution manometry impedance (P-HRM-I). We aimed to establish methodology to diagnose disorders utilizing P-HRM-I, hypothesizing that the objective measures could be used to diagnose disordered deglutition evidenced by greater aspiration scores. METHODS Patients (n = 509, 18-91 years) were compared to controls (n = 120, 20-94 years). Variables measuring UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contractile strength were derived for 10 ml liquid swallows. Three associated pharyngeal pressurization patterns, which may be indicative of obstructed flow, were characterized: pan-pressurization (Type 1), distal compartmentalized pressurization (Type 2), and transient pressurization (Type 3). Deglutitive aspiration was determined from video fluoroscopy. RESULTS UES relaxation pressure was best able to differentiate patients from controls (T 6.528, p < 0.0001). Patients with abnormal relaxation pressure (>8 mmHg) more frequently exhibited pharyngeal pressurization patterns and had adjunct evidence of reduced luminal distensibility (high intrabolus pressure and/or reduced UES opening). Utilizing this information, a diagnostic scheme was devised identifying 138 patients with UES disorder. A further 96 patients without evidence of UES disorder had abnormally weak pharyngeal pressures, confirming propulsive disorder. Amongst a sub-sample of 320 patients undergoing video fluoroscopy, those with pharyngeal pressurizations and adjunct evidence of reduced UES relaxation and/or distensibility had higher aspiration scores (Chi-square 60.169, p < 0.0001). CONCLUSION P-HRM-I can provide evidence for UES disorder based on pharyngeal pressurization patterns and abnormal findings for UES relaxation pressure, UES opening, and intrabolus pressure. Measuring pharyngeal contractility requires further optimization.
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Affiliation(s)
- Taher Omari
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Peter Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Michal Marcin Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Mistyka Schar
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jan Tack
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium
| | - Nathalie Rommel
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium.,Deglutology, Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium
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Ueha R, Sato T, Goto T, Koyama M, Yamauchi A, Mizukami A, Yamasoba T. Effects of Aspiration Prevention Surgery on the Dynamics of the Pharynx and Upper Esophageal Sphincter. OTO Open 2021; 5:2473974X211048505. [PMID: 34708180 PMCID: PMC8543729 DOI: 10.1177/2473974x211048505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Oral intake after aspiration prevention surgery (APS) is influenced by postoperative pharyngeal pressure and the dynamics of the upper esophageal sphincter (UES). We examined the effects of less invasive APS combined with UES relaxation techniques (laryngeal closure with cricopharyngeal myotomy [LC-CPM] and central-part laryngectomy [CPL]) on pharyngeal pressure and UES dynamics. Study Design Retrospective, observational study. Setting Single center. Methods We assessed the high-resolution pharyngeal manometric parameters of patients who underwent APS from 2018 to 2020. Then, we compared the effects of bilateral cricopharyngeal myotomy (combined with LC: LC-CPM group) and total cricoidectomy (CPL group) on both pharyngeal pressure and UES dynamics pre- and postoperatively. Results Eighteen patients (median age, 68 years; 17 men [94%]) were enrolled. Primary diseases associated with severe aspiration were neuromuscular disorders in 13, stroke in 3, and others in 2 patients. Pharyngeal swallowing pressure did not significantly change before and after APS. UES resting pressure and UES relaxation duration were significantly reduced (P < .001) and prolonged (P < .001), respectively, after APS. Only the CPL group (8 patients: median 62 years, all men) showed an increase in the velopharyngeal closure integral after APS (P < .05). More prolonged UES relaxation duration was recognized postoperatively in the CPL group (P < .01) than in the LC-CPM group. Conclusion Less invasive APS minimally affects pharyngeal swallowing pressure, decreases UES resting pressure, and prolongs UES relaxation duration. CPL may be more effective for postoperative UES relaxation in patients with a short UES relaxation time.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, University of Tokyo Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Aiko Mizukami
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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9
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The upper esophageal sphincter in the high-resolution manometry era. Langenbecks Arch Surg 2021; 406:2611-2619. [PMID: 34462811 DOI: 10.1007/s00423-021-02319-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM). METHODS This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era. RESULTS We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation). CONCLUSION This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.
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Aihara K, Inamoto Y, Kanamori D, González-Fernández M, Shibata S, Kagaya H, Hirano S, Kobayashi H, Fujii N, Saitoh E. Effect of tongue-hold swallow on posterior pharyngeal wall using dynamic area detector computed tomography. J Oral Rehabil 2021; 48:1235-1242. [PMID: 34407238 PMCID: PMC9291453 DOI: 10.1111/joor.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/15/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
Purpose The purpose of this study was to elucidate the effects of the tongue‐hold swallow (THS) on the pharyngeal wall by quantifying posterior pharyngeal wall (PPW) anterior bulge during the THS. In addition, the effect of tongue protrusion length on the extent of pharyngeal wall anterior bulge was analysed. Methods Thirteen healthy subjects (6 males and 7 females, 23–43 years) underwent 320‐row area detector CT during saliva swallow (SS) and THS at two tongue protrusion lengths (THS1 protrude the tongue as much as 1/3 of premeasured maximum tongue protrusion length (MTP‐L) and THS2 protrude the tongue as much as 2/3 of MTP‐L). To acquire images of the pharynx at rest, single‐phase volume scanning was performed three times during usual breathing with no tongue protrusion (rest), protrusion of the tongue at 1/3 of MTP‐L (rTHS1) and protrusion of the tongue at 2/3 of MTP‐L (rTHS2). Length from cervical spine to PPW (PPW‐AP) and the volume of pharyngeal cavity was measured and was compared between rest, rTHS1 and rTHS2 and between SS, THS1 and THS2. Correlation between MTP‐L and PPW‐AP was calculated in three conditions, SS, THS1 and THS2. Results PPW‐AP at rest, rTHS1 and rTHS2 was 2.9 ± 0.6 mm, 3.0 ± 0.5 mm and 3.0 ± 0.5 mm, respectively, showing no significant differences across swallows. PPW‐AP at the maximum pharyngeal constriction was 8.1 ± 2.0 mm, 9.1 ± 2.4 mm and 8.7 ± 2.0 mm in SS, THS1 and THS2, respectively. Compared to SS, PPW‐AP in THS1 was significantly larger (p = 0.04) and PPW‐AP in THS2 was not significantly different (p = 0.09). Pharyngeal volume at rest, rTHS1 and rTHS2 was 16.4 ± 5.2 mm3, 18.4 ± 4.5 mm3 and 21.3 ± 6.2 mm3, respectively. It was significantly larger during rTHS2 compared with rest or rTHS1 (rTHS2‐rest p = 0.007, rTHS2‐rTHS1 p = 0.007). Pharyngeal volume was completely obliterated (zero volume) at maximum pharyngeal contraction in all except one subject. There was no correlation between MTP‐L and PPW‐AP in any of the three conditions (SS, THS1 and THS2). Discussion This study demonstrated that the expanded pharyngeal cavity due to the tongue protrusion was completely obliterated by the increase in anterior motion of pharyngeal wall during THS. It also became clear that the degree of tongue protrusion did not linearly correlate with the movement of PPW during THS. There was no relationship between PPW motion and the MTP‐L, suggesting that the effect of tongue protrusion is better determined in each subject by analysing the motion of PPW using imaging tools.
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Affiliation(s)
- Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Daisuke Kanamori
- Department of Density and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroko Kobayashi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Naoko Fujii
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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