Simultaneous manometry and electromyography in the pharyngoesophageal segment

Overbeek, Jos J. M. van; Paping, Richard H. L.

doi:10.1288/00005537-198505000-00011

Cited by 57 publications

(38 citation statements)

References 10 publications

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“…Pressures in the hypopharynx are generated through contraction of the middle and inferior constrictor muscles but also have non-muscular pressures with inversion of the epiglottis and contact with other cartilaginous structures of the larynx [103,113]. Finally, UES pressures are comprised of muscular activity from the inferior constrictor, cricopharyngeus, and the circular skeletal muscles in the cervical esophagus [114][115][116][117]. The bolus also exerts a measurable pressure during passage through the UES [118][119][120], and there are additional pressure components from positioning of the larynx and other regional pharyngeal structures [114,121].…”

Section: Discussionmentioning

confidence: 99%

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Jones

Meisner

Broadfoot

et al. 2018

Front. Appl. Math. Stat.

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Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter (UES) reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3-10 consecutive swallows had no overall difference in variability, but sets of two swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

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Section: Discussionmentioning

confidence: 99%

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Jones

Meisner

Broadfoot

et al. 2018

Front. Appl. Math. Stat.

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“…Closure is probably effected by a combination of special anatomy and resting tone of the muscle fibers. We investigated the complex mechanism of deglutition by simultaneously performed manometry and electromyography (EMG) at different levels in the pharyngoesophageal segment in humans [3]. That study demonstrated that UES closure is produced by a resting tone and that opening is effected by relaxation of the muscle fibers (Fig.…”

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confidence: 99%

Upper esophageal sphincterotomy in dysphagic patients with and without a diverticulum

Overbeek

1991

Dysphagia

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Symptoms of high dysphagia are sometimes too readily interpreted as symptoms of globus. When patients have unmistakable difficulties during meals, focused diagnostic procedures are indicated. The upper esophageal sphincter (UES) is the key structure at the transition from hypopharynx to esophagus. In many disorders presenting with dysphagia, the UES mechanism remains intact and can cause the symptoms. Especially in patients with a hypopharyngeal (Zenker's) diverticulum and in patients with a hypopharyngeal paralysis due to a neurologic disorder, sphincterotomy may be indicated. In the microendoscopic treatment of Zenker's diverticulum, a transmucosal sphincterotomy is created and at the same time a more ample overflow from diverticulum to esophagus is effected. In view of our results in 507 patients we are justified in maintaining that this procedure can be regarded as a safe and effective treatment. In patients with neurologic dysphagia, sphincterotomy by an external approach can ensure adequate passage of food from the hypopharynx to the esophagus, resulting in marked improvement of the dysphagic symptoms. Our technique and results of external approach sphincterotomy are described here.

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“…Undoubtedly age and size of Killian's triangle have an important influence on the development of the hypopharyngeal diverticulum. The weakness of Killian's triangle is aggravated by decreasing tissue elasticity and a lower muscle tone in the elderly patient [12]. Additionally, van Overbeek [13] observed in his patient contingent a certain familial incidence.…”

Section: Discussionmentioning

confidence: 90%

“…According to patho-anatomical conditions myotomy of the cricopharyngeal muscle is generally thought to be the most important part of surgery no matter what surgical approach is chosen [14,15]. The narrowest part of the pharyngoesophageal segment is widened and the intraluminal pressure of the hypopharynx is lowered during swallowing [12,13]. In addition to the myotomy, the diverticulum sac is resected during transcutaneous operation.…”

Section: Discussionmentioning

confidence: 99%