Original research
Findings of Abnormal Videofluoroscopic Swallowing Study Identified by High-Resolution Manometry Parameters

https://doi.org/10.1016/j.apmr.2015.10.084Get rights and content

Abstract

Objective

To identify the parameters of high-resolution manometry (HRM) with a significant correlation to abnormal findings of videofluoroscopic swallowing study (VFSS).

Design

Prospective study.

Setting

Hospital rehabilitation department.

Participants

Patients with dysphagia symptoms (N=40).

Intervention

Participants were evaluated once using VFSS in neutral head position and evaluated twice using HRM with 5mL of thin fluid.

Main Outcome Measures

HRM parameters included maximal pressure, area integral, rise time, duration of the velopharynx and tongue base, maximal pressure of pre–upper esophageal sphincter (UES), low pharynx, cricopharyngeus, minimal UES pressure, UES activity time, and nadir UES duration. HRM parameters were compared with the findings of VFSS. Receiver operating characteristic analysis was performed to obtain the cutoff value, sensitivity, and specificity of HRM parameters for the prediction of findings of VFSS.

Results

The maximum pressure of the velopharynx showed a significantly positive prediction for most abnormal parameters of VFSS in the pharyngeal phase. Nadir UES pressure duration was significant for impaired laryngeal elevation, residue at pyriformis sinus, and combination of penetration and aspiration. The maximum pressure of the velopharynx <180.0 showed 100% sensitivity and 75% specificity for the presence of penetration and aspiration, and the cutoff point of 178.8 showed 86.7% sensitivity and 75% specificity for the presence of subglottic aspiration.

Conclusions

This study identified significant HRM parameters that are highly specific for individual abnormalities of VFSS, suggesting the cutoff value, sensitivity, and specificity. Because HRM could inform the quantitative measurement of pharyngeal weakness, the cutoff value for HRM parameters could be used to predict aspiration in patients with pharyngeal weakness.

Section snippets

Participants

This study was a prospective observational study conducted from August 11, 2014, to November 31, 2014. Forty patients were enrolled, including both inpatients and outpatients, who had dysphagia symptoms with stable vital signs; they were all physically able to participate in the study, providing consent to participate. Patients with dysphagia reported at least 1 symptom of dysphagia (eg, food sticking, cough with eating, globus sensation, diet change). The following patients were excluded:

Findings of VFSS

Among the 40 participants, 16 showed delayed swallowing reflex and impaired laryngeal elevation. Moreover, supraglottic penetration was observed in 4 subjects, and subglottic aspiration was observed in 18 subjects (see table 2).

Significant HRM variables according to VFSS parameters

Variables with highly positive prediction in a univariate logistic analysis are listed on table 3 (P<.05). The maximum VP pressure showed a significant positive prediction for most abnormal parameters of VFSS in the pharyngeal phase. Nadir UES pressure duration was

Discussion

Safe swallowing requires precise coordination of neuromuscular events to generate pressure gradients that propel a bolus from the mouth to the esophagus.9, 21, 22, 23 An inability to generate adequate oropharyngeal pressure has been correlated with dysphagia.9, 24 The purpose of this study was to identify the correlations between dysphagia and sequential pharyngeal pressure events. Therefore, we compared the HRM parameters with abnormalities visible in VFSS. By making such a comparison, we

Conclusions

Because the movement of swallowing is mediated by several important muscular contractions that generate pressure, muscular weakness of pharyngeal structure might be one of the most important mechanisms for developing dysphagia. In this study, we found that significant HRM parameters are highly specific to abnormal findings of VFSS. We suggested the cutoff value, sensitivity, and specificity for these findings. Because HRM could inform the quantitative measurement of pharyngeal weakness, the

Suppliers

  • a.

    Sandhill Scientific Instruments.

  • b.

    SPSS for Windows version 21.0; SPSS.

  • c.

    R package for Windows version 2.15.2; R Foundation for Statistical Computing.

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    Supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, Information/Communication Technology and Future Planning (grant no. NRF-2013R1A1A1004622).

    Disclosures: none.

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