Relationship Between Tongue Base Region Pressures and Vallecular Clearance

Abstract

Tongue base pressures have been thought to provide primary bolus clearance through the pharynx during swallowing. The relationship between bolus driving pressures and residue remaining in the valleculae after the swallow has not been defined. Thirty-seven dysphagic patients who were evaluated with both videofluoroscopy (VFSS) and high-resolution manometry (HRM) were identified within the University of Wisconsin Voice and Swallowing Outcomes database. Patients were categorized according to binary ratings of presence or absence of vallecular stasis as well as incomplete or complete tongue retraction on VFSS. Tongue base region pressures measured with HRM during saline swallows of 1 and 10 ml volumes were compared to ratings of vallecular stasis or tongue base retraction. No significant difference could be identified among mean peak HRM pressures when compared to presence or absence of vallecular stasis (1 ml saline: p = .1886; 10 ml saline: p = .7354). When categorized according to complete or incomplete tongue retraction, mean peak HRM pressures were significantly greater in the complete tongue retraction group as compared to incomplete tongue retraction (1 ml saline: p = .0223; 10 ml saline: p = .0100). Findings suggest there are multiple factors that lead to reduced vallecular clearance. In the absence of HRM measures, judging complete or incomplete tongue retraction on VFSS may be a more valid gauge of tongue base region pressures than vallecular clearance when planning dysphagia treatment.

Pharyngeal swallowing pressures in the base‐of‐tongue and hypopharynx regions identified with three‐dimensional manometry

“…Focus is often placed on the assessment of the tongue base movement clinically on videofluoroscopy, and incomplete retraction has been associated with a reduction in base-oftongue regional pressures. 26 As such, we had predicted that in a healthy pharynx, anterior pressures would be close in value to their posterior counterparts. However, this was not the case.…”

“…In line with the distinct mechanism of muscular activity and the character of the pressure traces, pressure integrals in this region were notably higher than in the hypopharynx. Focus is often placed on the assessment of the tongue base movement clinically on videofluoroscopy, and incomplete retraction has been associated with a reduction in base‐of‐tongue regional pressures . As such, we had predicted that in a healthy pharynx, anterior pressures would be close in value to their posterior counterparts.…”

“…This study was approved by the institutional review board of the University of Wisconsin-Madison. Data were collected from four males and eight females (n 5 12) with a mean age of 22 years (range: [21][22][23][24][25][26][27][28][29]. Participants had no known history of swallowing, neurological, or gastroenterological pathology and, to avoid the potential effects of a full stomach, were instructed to refrain from consuming solid foods for 4 hours and liquids for 2 hours before the study.…”

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

“…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].…”

“…This inherently improves the reliability of catheter placement, as the uppermost sensor can be positioned immediately inside the naris in all participants and the length of the upper aerodigestive tract can be evaluated in its entirety. Robust spatial resolution paired with the high temporal resolution has increased the popularity of pharyngeal HRM in research [76,77,78,79,80]. …”