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To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia.
Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined.
VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia.
We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.
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Method: We retrospectively reviewed the clinical characteristics and VFSS findings in thirteen patients with esophageal cancer and stricture. Videofluoroscopic parameters of oral, pharyngeal, and esophageal phases were measured. Patients were divided into three groups according to their diseases: Group A, esophageal cancer with esophagectomy (5 patients); Group B, esophageal cancer with non-operative treatment (3 patients); and Group C, esophageal stricture with surgical treatment (5 patients).
Results: Group A had vocal cord palsy (VCP) after esophagectomy, and all patients showed poor laryngeal closure and aspiration during swallowing. Group B received radiation therapy prior to VFSS and showed poor laryngeal closure and high pharyngeal residue with aspiration during and after swallowing. Group C received esophagectomy with anastomosis of lower gastrointestinal tract (stomach, jejunum, colon). Most had VCP and showed high pharyngeal residue, stricture of upper esophageal sphincter, and poor oral control with aspiration during and after swallowing.
Conclusion: Characteristics of dysphagia on VFSS were poor laryngeal closure in operated esophageal cancer patients. In patients of non-operated esophageal cancer and esophageal stricture, high pharyngeal residue and poor laryngeal closure were characterized. (J Korean Acad Rehab Med 2003; 27: 978-983)
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