The Reliability of Pharyngeal High Resolution Manometry with Impedance for Derivation of Measures of Swallowing Function in Healthy Volunteers

Abstract

Purpose. We evaluated the intra- and interrater agreement and test-retest reliability of analyst derivation of swallow function variables based on repeated high resolution manometry with impedance measurements. Methods. Five subjects swallowed 10 × 10 mL saline on two occasions one week apart producing a database of 100 swallows. Swallows were repeat-analysed by six observers using software. Swallow variables were indicative of contractility, intrabolus pressure, and flow timing. Results. The average intraclass correlation coefficients (ICC) for intra- and interrater comparisons of all variable means showed substantial to excellent agreement (intrarater ICC 0.85–1.00; mean interrater ICC 0.77–1.00). Test-retest results were less reliable. ICC for test-retest comparisons ranged from slight to excellent depending on the class of variable. Contractility variables differed most in terms of test-retest reliability. Amongst contractility variables, UES basal pressure showed excellent test-retest agreement (mean ICC 0.94), measures of UES postrelaxation contractile pressure showed moderate to substantial test-retest agreement (mean Interrater ICC 0.47–0.67), and test-retest agreement of pharyngeal contractile pressure ranged from slight to substantial (mean Interrater ICC 0.15–0.61). Conclusions. Test-retest reliability of HRIM measures depends on the class of variable. Measures of bolus distension pressure and flow timing appear to be more test-retest reliable than measures of contractility.

Effect of topical nasal anesthetic on swallowing in healthy adults: A double‐blind, high‐resolution manometry study

“…Previous studies prioritize comfort over possible sensory alterations, stating “the trade‐off of increased comfort at the expense of short‐term pain and temperature afferent alteration improved reliability of data” (p375) However, the present results indicate TNA provides no improvement in procedure comfort, consistent with previous publications using FEES . Further, studies using larger diameter catheters (up to 4.2 mm) have shown pharyngeal HRM procedure to be feasible without TNA …”

Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter

“…Although it could be argued that circumferential sensors are optimal for pharyngeal manometry the provision of circumferentially averaged results for each sensor is not necessarily akin to obtaining multiple separate, radially orientated readings . Furthermore, parameters of pharyngeal peristalsis, even when based on circumferentially averaged pressure measurements, have shown significant intra‐ and intersubject variability and poor test‐retest reproducibility of pharyngeal contractility measurements in particular . As the factors driving the measured pharyngeal occlusion pressure are clearly complex, we believe a redirection of attention to other, more reliable parameters, such as bolus distension area and pressure‐flow timing, is needed.…”

“…Thus, our potential to measure volume‐related contractile pressure differences in this region may be compromised. Studies investigating the symmetry of deglutitive pharyngeal and UES pressures using state‐of‐the‐art three‐dimensional high‐resolution impedance manometry catheters have recently been published . Although it could be argued that circumferential sensors are optimal for pharyngeal manometry the provision of circumferentially averaged results for each sensor is not necessarily akin to obtaining multiple separate, radially orientated readings .…”

“…Swallow function metrics were calculated within each region (see below), and were averaged per volume for each catheter configuration. The reliability of this method and the specific details of the analysis algorithms have been previously described …”

Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

“…Notable works that may translate to neonatal population include: 1) development of automated impedance manometry for pressure flow analysis 63,68–70 , 2) effect of GERD therapies in infants and children 71–77 , and the 3) effect of stimulus characteristics on esophageal function 78,79 .…”