High-Resolution Manometry of Pharyngeal Swallow Pressure Events Associated with Effortful Swallow and the Mendelsohn Maneuver

Abstract

Effortful swallow and the Mendelsohn maneuver are two common strategies to improve disordered swallowing. We used high-resolution manometry (HRM) to quantify the effects of these maneuvers on pressure and timing characteristics. Fourteen normal subjects swallowed multiple, five ml water boluses using three techniques: normal swallow; effortful swallow; and Mendelsohn maneuver. Maximum pressure, rate, duration, area integral, and line integral were determined for the velopharynx and tongue base. Minimum pressure, duration of pressure-related change, duration of nadir pressure, maximum pre-opening and post-closure pressure, area integral, and line integral were recorded for the upper esophageal sphincter (UES). Area and line integrals of the velopharyngeal pressure curve significantly increased with the Mendelsohn maneuver; the line integral increased with the effortful swallow. Pre-opening UES pressure decreased significantly for the Mendelsohn, while post-closure pressure tended to increase insignificantly for both maneuvers. UES area and line integrals as well as nadir UES pressure duration increased with both maneuvers. Maneuver-dependent changes were observed primarily at the velopharynx and UES. These regions are critical to safe swallowing, as the velopharynx provides positive pressure at the bolus tail while the UES allows a bolus to enter the esophagus without risk of regurgitation. Integrals were more responsive than maximum pressure or duration and should be investigated further.

The Effects of Bolus Volume and Texture on Pharyngeal Pressure Events Using High-resolution Manometry and Its Comparison with Videofluoroscopic Swallowing Study

“…HRM has revealed subtle pressure differences not previously detected by conventional manometry successfully. [6][7][8][9][10] As HRM measures the pressure generation in pharyngeal structures, the main target structures are the velopharynx (VP), TB, epiglottis, and the UES. 7,11 VP is the region between the soft palate and pharyngeal wall.…”

The Relationship Between Submental Surface Electromyography and Hyo-Laryngeal Kinematic Measures of Mendelsohn Maneuver Duration

“…The Mendelsohn Maneuver (MM) is a swallowing maneuver that involves volitionally prolonging the duration of hyolaryngeal elevation during swallowing, which also affects upper esophageal sphincter opening durations, according to some reports (Boden, Hallgren, & Witt Hedström, 2006;Hoffman et al, 2012;Kahrilas et al, 1991). Since the kinematics of swallowing are internal, hyo-laryngeal movements during MM performance have been viewed with videofluoroscopy (VFS; Kahrilas et al, 1991).…”

Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

“…Pharyngeal HRM is limited by a seldom-reported measurement error in the ManoScan™ system, used widely in research [52,73,81,82,88,92,93,94,95]. A pressure drift has been found to refute the manufacturer's report that pressure uniformity remains within 2 mm Hg for 4 h or less of recording [93,96].…”

“…Research applications of HRM rely heavily on software such as MATLAB to analyse pharyngeal swallowing with custom algorithms outside of commercial HRM devices [78,79,80,81,82,83,91], and reliability of pharyngeal HRM is limited to one study investigating a custom MATLAB programme. The reliability of a custom-designed software programme was evaluated after provision of a 20-min training session to 20 raters with varying experience (e.g., expert and novice speech-language pathologists) [91].…”

“…Pharyngeal HRM has been used to evaluate normal swallowing [18] and swallowing using various manoeuvres, including tongue hold [81], effortful swallowing [18,82], the Mendelsohn manoeuvre [82], head turn and chin tuck [63,64]. Differences in bolus sizes and textures have additionally been evaluated [83,84].…”