This study analyzes the differences between wet and dry swallows; a manofluorogram is used to determine forces that affect pharyngeal bolus flow. By defining bolus pressures, many of the limitations of pharyngeal manometry are surmounted. This makes manometry a more useful clinical tool. The study results indicate that only a small portion of pharyngeal-generated pressure is directly applied to the bolus. The manofluorogram demonstrates that bolus transit relies on the synergistic action of two pumps--the oropharyngeal propulsion pump and the hypopharyngeal suction pump. A technique is illustrated for quantifying the forces that affect bolus flow. Quantification of force can differentiate abnormal forces responsible for lingual, pharyngeal, and hypopharyngeal pathology in dysphagic patients. The degrees of impairment can be measured.

Among cochlear implant candidates there are patients who have abnormal middle and/or inner-ear conditions that make them unsuitable for implantation. Insertion of a foreign body may also be contraindicated in the setting of an existing or potential intracranial communication, or when the ear is prone to infection. Five patients presented with such unfavorable conditions. These included a Mondini dysplasia with persistent cerebrospinal fluid leak, an atretic mastoid with meningocele, chronic otitis media, a transverse petrous bone fracture, and a temporal bone adenoma. All patients underwent subtotal petrosectomies and cochlear implantations. In four cases implantation was performed concomitantly with subtotal petrosectomy, while the remaining case required a two-stage procedure. No complications occurred. The technique is described in detail, and the cases and the indications for surgery are discussed. By obliterating and isolating the tympanomastoid cleft from the outer environment and utilizing the technique of subtotal petrosectomy, a broader spectrum of patients can now be implanted safely.

swallowing depends on the synergistic motion of the tongue, larynx, and pharyngeal wall to develop a bolus pressure gradient for bolus transit. However, few studies have provided timing relationships for clinical evaluations. To examine the timing relationships of pharyngeal anatomic motion, pressure generation, and bolus transit in the normal swallow, this study uses a new method, manofluorography, to correlate these swallowing aspects. Thirty-one events were timed by analyzing five swallows each in 14 normal subjects. A different perspective of pharyngeal physiology is presented.

Swallowing can become a problem for people with advanced age or laryngeal cancer, especially after surgical resection. The purpose of this study was to quantify the mechanical transport of the bolus through the throat by simultaneously comparing the instantaneous position and velocity of the bolus to the generation of pressure at different sites in the oropharyngeal cavity. Swallows of barium liquid were analyzed using Manofluorography, which simultaneously recorded pressure and barium position through a split screen display. Frame-by-frame analysis was used to describe bolus motion. The graph of head and tail movement showed an hourglass shape with an initial slow, then rapid movement of the bolus head. The peak bolus head velocity averaged 47 cm/s and the maximum acceleration was 460 cm/s2. Comparison of pressure traces with the kinematic curves revealed the relative timings of tongue movement, negative suction pressure from the pharyngoesophageal segment and the contraction wave. The magnitude of the gravity and resistance forces were estimated and relative strengths compared. The pharynx can be viewed as a dynamic conduit with changing diameters. The tongue driving force initially drove the bolus. Laryngeal elevation and the pharyngoesophageal segment developed a prebolus negative suction pressure ahead of the bolus. For vertical swallowing of the barium liquid, gravity played the dominant role in head transport. Contraction of the pharyngeal walls served to clear the tail of the bolus from the pharynx. These results aid in the understanding of the physiology of normal swallowing and provide quantitative data for the evaluation of oropharyngeal reconstruction.