High-resolution manometry of pharyngeal swallow pressure events associated with head turn and chin tuck

Abstract

Objectives: We quantified the effect of swallowing maneuvers on pharyngeal pressure events using high-resolution manometry.

Methods: Seven subjects swallowed multiple 5-mL water boluses in 3 different postural conditions: neutral, head turn, and chin tuck. Pressure and timing events were recorded with a 36-sensor high-resolution manometry catheter. We analyzed the regions of the velopharynx and the base of the tongue for maximum pressure, rate of pressure increase, pressure gradient, and duration of pressure above baseline. In the region of the upper esophageal sphincter (UES), we analyzed the duration of pressure declination, minimum pressure during UES opening, and maximum pressures before and after UES opening.

Results: The maneuvers did not have a significant effect on maximum pressure, rate of pressure increase, or pressure gradients in the velopharyngeal or tongue base regions. The duration of pressure above baseline was significantly longer in the velopharynx for head turn. The preswallow maximum UES pressure was significantly greater for neutral swallows than for head turn, and the postswallow maximum pressure was significantly lower for chin tuck. Both maneuvers appeared to prolong UES pressure declination duration, but neither prolongation reached significance.

Conclusions: High-resolution manometry allows for optimal spatial and temporal resolution during recording of pressure events along the length of the pharynx, and revealed previously undetected task-dependent pressure and timing differences during chin tuck and head turn in healthy adults. These maneuvers appear to influence the UES to a greater degree than the velopharynx or the tongue base. Further studies designed to quantify the effect of other maneuvers and bolus consistencies on the generation of pharyngeal pressure events both in normal and in disordered subjects may lead to hypothesis-driven, optimal, individualized swallowing therapies.

Figure 1

Spatiotemporal plot of 5 ml swallow in the head turn position. A. Total catheter length within pharynx (rostral boundary is the nasopharynx and caudal boundary is the upper esophageal sphincter (UES) (12 cm in this subject).

Figure 2

Spatiotemporal plots of neutral (left), head turn (middle), and chin tuck (right) swallows from one subject. Catheter position is on the y-axis, time is on the x-axis, and pressure is indicated by the color scale. A – velopharyngeal pressure; B – tongue base pressure; C – pre-swallow UES pressure peak; D – UES relaxation pressure; E – post-swallow UES pressure peak; (UES opening time is the time duration between D and E); F – increased duration of velopharyngeal pressure above baseline during head turn; G – decreased pre-swallow UES pressure during head turn; H – further subatmospheric UES relaxation pressure during head turn; I – increased duration of velopharyngeal pressure above baseline during chin tuck; J – decreased post-swallow UES pressure peak during chin tuck.

Figure 3

Maximum and minimum pressures at the UES region associated with 5 ml water swallow during each swallow task. Mean and Standard deviations with * identifying significant difference relative to Neutral head position (α = 0.05).

Figure 4

Duration of UES opening (top) and duration of the total pharyngeal swallow (bottom)

Figure 5

Gradients in velopharynx (A) and tongue base (B) for each swallowing task. Measurements were recorded at the maximum pressure within a region (max), and the pressure at the same time point one (1 cm) and two (2 cm) sensors downstream. Min represents the baseline pressure recorded at the same sensor as the maximum pressure.