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Association of the “Jet Phenomenon” with Positive Symptom Outcome Following Surgical Treatment of Cricopharyngeus Muscle Dysfunction

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Abstract

Objectives

Cricopharyngeus muscle dysfunction (CPMD) is a common cause for progressive dysphagia and can lead to dietary restriction, reduced nutrition, weight loss, and pneumonia. Controversy exists whether CPMD is best managed with primary surgical treatment of the cricopharyngeus muscle and who represents a good surgical candidate.

Methods

Retrospective review of patients diagnosed with CPMD who underwent surgical treatment were evaluated through prospectively collected pre- and postoperative Eating Assessment Tool-10 (EAT-10) and Functional Oral Intake Scale (FOIS). Videofluoroscopic swallowing studies (VFSS) were reviewed for presence or absence of a high-pressure barium stream through the upper esophageal sphincter, termed the jet phenomenon (JP).

Results

We identified 42 patients with CPMD who underwent surgical treatment and had serial Eating Assessment Tool (EAT-10) measures obtained pre- and postoperatively. Mean EAT-10 scores improved by 12.1 points (95%CI = 8.6–15.6), p < 0.0001. There was a significantly greater improvement among patients with JP (|∆EAT-10|= 17.0, 95%CI = 12.5–21.4) compared to those without (|∆EAT-10|= 6.2, 95%CI = 1.6–10.8), p = 0.0013. Patients with JP also showed improved FOIS score (p = 0.0023) while those without JP did not.

Conclusion

This study provides the initial report on the utility of JP as a VFSS feature that is strongly associated with improved outcomes following surgical treatment of CPMD. Further work determining the physiologic correlates responsible for JP will help clarify its predictive capabilities.

Level of Evidence

Level 3.

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References

  1. Hoy M, Domer A, Plowman EK, Loch R, Belafsky P. Causes of dysphagia in a tertiary-care swallowing center. Ann Otol Rhinol Laryngol. 2013;122:335–8. https://doi.org/10.1177/000348941312200508.

    Article  PubMed  Google Scholar 

  2. Allen JE. Cricopharyngeal function or dysfunction: what’s the deal? Curr Opin Otolaryngol Head Neck Surg. 2016;24:494–9.

    Article  PubMed  Google Scholar 

  3. Yin T, Jardine M, Miles A, Allen J. What is a normal pharynx? A videofluoroscopic study of anatomy in older adults. Eur Arch Oto-Rhino-Laryngol. 2018;275:2317–23.

    Article  Google Scholar 

  4. Kelly JH. Management of upper esophageal sphincter disorders: indications and complications of myotomy. Am J Med. 2000;108(Suppl 4a 4):43–6. https://doi.org/10.1016/S0002-9343(99)00334-4.

    Article  Google Scholar 

  5. Knigge MA, Thibeault SL. Swallowing outcomes after cricopharyngeal myotomy: a systematic review. Head Neck. 2018;40:203–12. https://doi.org/10.1002/HED.24977.

    Article  PubMed  Google Scholar 

  6. Sanei-Moghaddam A, Kumar S, Jani P, Brierley C. Cricopharyngeal myotomy for cricopharyngeus stricture in an inclusion body myositis patient with hiatus hernia: a learning experience. BMJ Case Rep. 2013. https://doi.org/10.1136/bcr-2012-008058.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Triadafilopoulos G, Hallstone A, Nelson-Abbott H, Bedinger K. Oropharyngeal and esophageal interrelationships in patients with nonobstructive dysphagia. Dig Dis Sci. 1992;37:551–7. https://doi.org/10.1007/BF01307579.

    Article  CAS  PubMed  Google Scholar 

  8. Reedy EL, Herbert TL, Bonilha HS. Visualizing the esophagus during modified barium swallow studies: a systematic review. Am J Speech-Lang Pathol. 2021;30:761–71. https://doi.org/10.1044/2020_AJSLP-20-00255.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nativ-Zeltzer N, Rameau A, Kuhn MA, Kaufman M, Belafsky PC. The relationship between hiatal hernia and cricopharyngeus muscle dysfunction. Dysphagia. 2019;34:391–6.

    Article  PubMed  Google Scholar 

  10. Benjamin T, Zackria S, Lopez R, Richter J, Thota PN. Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux. Scand J Gastroenterol. 2017;52:816–21. https://doi.org/10.1080/00365521.2017.1322139.

    Article  PubMed  Google Scholar 

  11. Balouch B, Vaid A, Vontela S, Alnouri G, Sataloff RT. Anatomic and manometric abnormalities of the upper and lower esophageal sphincters in patients with reflux disease. J Voice. 2022. https://doi.org/10.1016/J.JVOICE.2021.11.008.

    Article  PubMed  Google Scholar 

  12. Chavez YH, Ciarleglio MM, Clarke JO, Nandwani M, Stein E, Roland BC. Upper esophageal sphincter abnormalities: frequent finding on high-resolution esophageal manometry and associated with poorer treatment response in achalasia. J Clin Gastroenterol. 2015;49:17–23. https://doi.org/10.1097/MCG.0000000000000157.

    Article  CAS  PubMed  Google Scholar 

  13. Blais P, Bennett MC, Gyawali CP. Upper esophageal sphincter metrics on high-resolution manometry differentiate etiologies of esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2019. https://doi.org/10.1111/NMO.13558.

    Article  PubMed  Google Scholar 

  14. Henderson RD, Hanna WM, Henderson RF, Marryatt G. Myotomy for reflux-induced cricopharyngeal dysphagia: five year review. J Thorac Cardiovasc Surg. 1989;98:428–33.

    Article  CAS  PubMed  Google Scholar 

  15. Williams RBH, Ali GN, Hunt DR, Wallace KL, Cook IJ. Cricopharyngeal myotomy does not increase the risk of esophagopharyngeal acid regurgitation. Am J Gastroenterol. 1999;94:3448–54. https://doi.org/10.1111/j.1572-0241.1999.01507.x.

    Article  CAS  PubMed  Google Scholar 

  16. Allen J, White CJ, Leonard R, Belafsky PC. Effect of cricopharyngeus muscle surgery on the pharynx. Laryngoscope. 2010;120:1498–503.

    Article  PubMed  Google Scholar 

  17. Yip HT, Leonard R, Kendall KA. Cricopharyngeal myotomy normalizes the opening size of the upper esophageal sphincter in cricopharyngeal dysfunction. Laryngoscope. 2006;116:93–6. https://doi.org/10.1097/01.mlg.0000184526.89256.85.

    Article  PubMed  Google Scholar 

  18. Wu PI, Szczesniak MM, Omari T, Lam TY, Wong M, Maclean J, et al. Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease. Endosc Int open. 2021;9:E1811–9. https://doi.org/10.1055/A-1562-7107.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fong R, Rumbach AF, Ward EC, Doeltgen SH, Sun N, Tsang R. Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo-esophageal dysphagia associated with nasopharyngeal cancer: a case series. Laryngoscope Investig Otolaryngol. 2021;6:1077–87. https://doi.org/10.1002/LIO2.641.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kos MP, David EF, Klinkenberg-Knol EC, Mahieu HF. Long-term results of external upper esophageal sphincter myotomy for oropharyngeal dysphagia. Dysphagia. 2010;25:169. https://doi.org/10.1007/S00455-009-9236-X.

    Article  PubMed  Google Scholar 

  21. Knigge MA, Thibeault S. Relationship between tongue base region pressures and vallecular clearance. Dysphagia. 2016;31:391–7. https://doi.org/10.1007/S00455-015-9688-0.

    Article  PubMed  Google Scholar 

  22. Rosen SP, Jones CA, Hoffman MR, Knigge MA, McCulloch TM. Pressure abnormalities in patients with Zenker’s diverticulum using pharyngeal high-resolution manometry. Laryngoscope Investig Otolaryngol. 2020;5:708–17. https://doi.org/10.1002/LIO2.434.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Krekeler BN, Davidson K, Kantarcigil C, Pearson W, Blair J, Martin-Harris B. Determining swallowing biomechanics underlying modified barium swallow impairment profile scoring using computational analysis of swallowing mechanics. J Speech Lang Hear Res. 2022. https://doi.org/10.1044/2022_JSLHR-22-00047.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hosseini P, Tadavarthi Y, Martin-Harris B, Pearson WG. Functional modules of pharyngeal swallowing mechanics. Laryngoscope Investig Otolaryngol. 2019;4:341–6. https://doi.org/10.1002/LIO2.273.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Randall DR, Chan R, Gomes D, Walker K. Natural history of cricopharyngeus muscle dysfunction symptomatology. Dysphagia. 2021. https://doi.org/10.1007/S00455-021-10355-8.

    Article  PubMed  Google Scholar 

  26. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74. https://doi.org/10.1111/nmo.12477.

    Article  CAS  PubMed  Google Scholar 

  27. Crary MA, Carnaby Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–20. https://doi.org/10.1016/j.apmr.2004.11.049.

    Article  PubMed  Google Scholar 

  28. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919–24. https://doi.org/10.1177/000348940811701210.

    Article  PubMed  Google Scholar 

  29. Belafsky PC, Rees CJ, Allen J, Leonard RJ. Pharyngeal dilation in cricopharyngeus muscle dysfunction and Zenker diverticulum. Laryngoscope. 2010;120:889–94.

    PubMed  Google Scholar 

  30. Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Improved symptomatic, functional, and fluoroscopic outcomes following serial “series of three” double-balloon dilation for cricopharyngeus muscle dysfunction. J Otolaryngol—Head Neck Surg. 2018;47:35. https://doi.org/10.1186/s40463-018-0278-7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Drazner MH. The progression of hypertensive heart disease. Circulation. 2011;123:327–34. https://doi.org/10.1161/CIRCULATIONAHA.108.845792.

    Article  PubMed  Google Scholar 

  32. Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective assessment of videofluoroscopic swallow studies. Otolaryngol—Head Neck Surg (United States). 2017;156:901–5. https://doi.org/10.1177/0194599817691276.

    Article  Google Scholar 

  33. Cock C, Omari T. Diagnosis of swallowing disorders: how we interpret pharyngeal manometry. Curr Gastroenterol Rep. 2017. https://doi.org/10.1007/S11894-017-0552-2.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Berg HM, Persky MS, Jacobs JB, Cohen NL. Cricopharyngeal myotomy: a review of surgical results in patients with cricopharyngeal achalasia of neurogenic origin. Laryngoscope. 1985;95:1337–40. https://doi.org/10.1288/00005537-198511000-00008.

    Article  CAS  PubMed  Google Scholar 

  35. Ozgursoy OB, Salassa JR. Manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy for cricopharyngeal bar. Otolaryngol—Head Neck Surg (United States). 2010;142:735–40. https://doi.org/10.1016/j.otohns.2009.08.020.

    Article  Google Scholar 

  36. Ali GN, Wallace KL, Laundl TM, Hunt DR, DeCarle DJ, Cook IJ. Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia. Dysphagia. 1997;12:133–9. https://doi.org/10.1007/PL00009527.

    Article  CAS  PubMed  Google Scholar 

  37. Ren Y, Tang X, Chen F, Deng Z, Wu J, Nei S, et al. Myotomy of distal esophagus influences proximal esophageal contraction and upper esophageal sphincter relaxation in patients with achalasia after peroral endoscopic myotomy. J Neurogastroenterol Motil. 2016;22:78–85. https://doi.org/10.5056/JNM15098.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors acknowledge the mentors, colleagues, and collaborators within the physician and speech language pathology practices from whom we have had the opportunity to learn, and from which we were introduced to the jet phenomenon term and its role in dysphagia assessment. We did not create the term and cannot determine who the first person to do so was, so this manuscript acknowledges his or her keen observation and the subsequent collective knowledge.

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Authors and Affiliations

  1. Section of Otolaryngology—Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Derrick R. Randall

  2. Peter Lougheed Centre, Outpatient Dysphagia Clinic, Calgary, AB, Canada

    Derrick R. Randall & Kim Walker

  3. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Morgan Young-Speirs

  4. Speech Language Pathology, Department of Allied Health, South Health Campus, Calgary, AB, Canada

    Kim Walker

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  1. Derrick R. Randall
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Correspondence to Derrick R. Randall.

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Randall, D.R., Young-Speirs, M. & Walker, K. Association of the “Jet Phenomenon” with Positive Symptom Outcome Following Surgical Treatment of Cricopharyngeus Muscle Dysfunction. Dysphagia 38, 1440–1446 (2023). https://doi.org/10.1007/s00455-023-10573-2

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