The indications for, and predictors of outcome following cricopharyngeal disruption in pharyngeal dysphagia are not clearly defined. Our purpose was to examine the symptomatic response to cricopharyngeal disruption, by either myotomy or dilatation, in patients with oral-pharyngeal dysphagia and to determine pre-treatment manometric or radiographic predictors of outcome. Using simultaneous pharyngeal videoradiography and manometry, we studied 20 patients with pharyngeal dysphagia prior to cricopharyngeal dilatation (n = 11) or myotomy (n = 8), and 23 healthy controls. We measured peak pharyngeal pressure, hypopharyngeal intrabolus pressure, upper esophageal sphincter diameter, and coordination. Response rate to sphincter disruption was 65%. The extent of sphincter opening was significantly reduced in patients compared with controls (p = 0.004), but impaired sphincter opening was not a predictor of outcome. Increased hypopharyngeal intrabolus pressures (> 19 mmHg for 10 ml bolus; > 31 mmHg for 20 ml bolus) was a significant predictor of outcome (p = 0.01). Neither peak pharyngeal pressure nor incoordination were predictors of outcome. In pharyngeal dysphagia, hypopharyngeal intrabolus pressure, and not peak pharyngeal pressure, is a predictor of response to cricopharyngeal disruption. The relationship between intrabolus pressure and impaired sphincter opening is an indirect measure of sphincter compliance which helps predict therapeutic response.

We examined the potential influence of cold stimulation of the anterior tonsillar pillars, before and after topical anesthesia, on the temporal linkage between the oral and pharyngeal components of the swallow. We hypothesized that if elicitation of the pharyngeal swallow were dependent upon stimulation of faucial mucosal receptors this response would be facilitated by cold tactile stimulation and inhibited by topical anesthesia. In 14 healthy volunteers undergoing simultaneous videoradiography and manometry we measured and compared regional transit and clearance times, and the timing of hyoid motion, upper esophageal sphincter relaxation, and opening within the swallow sequence. There was a significant, volume-dependent forward shift in timings of hyoid motion, upper esophageal sphincter (UES) relaxation profile, and opening which were influenced neither by cold stimulation nor topical anesthesia. Regional transit and clearance times and UES coordination were not influenced by cold stimulation. Pharyngeal clearance time was prolonged by tonsillar pillar anesthesia due to earlier arrival of the bolus head at this region (p = 0.002). We conclude that the normal pharyngeal swallow response is neither facilitated nor inhibited by prior cold tactile stimulation or topical anesthesia to the tonsillar pillars, respectively. These observations do not support the hypothesis that elicitation of the pharyngeal swallow response is dependent upon stimulation of mucosal receptors in the tonsillar arches.

The potential influence of mucosal sensory receptors on the regulation of oral-pharyngeal swallow events was studied in 15 healthy volunteers using simultaneous videoradiography and manometry. We determined the effects of selective pharyngeal and oral plus pharyngeal anesthesia on the following temporal and manometric measures in response to liquid and viscous swallows: regional transit and clearance times; motion of hyoid and larynx; upper esophageal sphincter relaxation, opening, and closure; and pharyngeal contraction wave characteristics. Under the influence of mucosal anesthesia no subjects demonstrated aspiration during deglutition. Neither regional transit and clearance times nor pharyngosphincteric coordination was influenced significantly by pharyngeal mucosal anesthesia or oral plus pharyngeal anesthesia. Although midpharyngeal and distal pharyngeal contraction amplitudes were not influenced by mucosal anesthesia, midpharyngeal contraction wave duration was reduced significantly by both pharyngeal (P = 0.02) and oral plus pharyngeal anesthesia (P = 0.0005). We conclude that 1) neither elicitation of the pharyngeal swallow response nor temporal regulation among swallow events is dependent on mucosal sensory receptors and 2) duration of the pharyngeal contraction is influenced by sensory input from the oral-pharyngeal mucosa.