Implementation of high-resolution manometry in the clinical practice of speech language pathology

Abstract

Visual imaging modalities, videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallow, for assessment of oropharyngeal dysphagia have been part of the speech language pathologist's (SLPs) armamentarium for the diagnosis and treatment of dysphagia for decades. Recently, the addition of high-resolution manometry (HRM) has enabled the SLP to evaluate pharyngeal pressures and upper esophageal sphincter relaxation. Taken together, the use of visual imaging modalities with HRM can improve interpretation of swallowing physiology and facilitate more effective treatment planning. The goal of this article is to describe a clinical paradigm using HRM as an adjunct to VFSS, by the SLP, in the assessment of complex dysphagia. Moreover, in three cases described, the value of manometric measurements in elucidating swallowing imaging studies and documenting physiologic change in response to treatment is highlighted. As technology in this area is evolving, so will the clinical use of HRM by the SLP. Limitations of current HRM systems and applications are discussed.

Fig. 1

HRM decision matrix

Fig. 2

Manometric catheter placement

Fig. 3

Normal swallowing spatiotemporal plot

Fig. 4

Spatiotemporal plots, Patient 1: 1 mL saline (a), 1 mL saline using head turn right with chin tuck (b), 5 mL with supraglottic swallow strategy (c), 5 mL with SGS and head turn right with chin tuck (d)

Fig. 5

Spatiotemporal plots, Patient 2: 1 mL, baseline (a), 1 mL, 12 week post-therapy (b), 5 mL, 12-week post-therapy, with lean to left (c), 5 mL, 26 weeks detraining, with lean to left (d)

Fig. 6

Spatiotemporal plots, Patient 3: 1 mL baseline (a), 1 mL using head turn left with chin tuck baseline (b), 1 mL post-therapy and surgical intervention (c), 1 mL post-therapy and surgical intervention using head turn left with chin tuck (d)