Pressure Flow Analysis in the Assessment of Preswallow Pharyngeal Bolus Presence in Dysphagia

Copyright © 2015 Lara Ferris et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Objectives. Preswallow pharyngeal bolus presence is evident in patients with oropharyngeal dysphagia. Pressure flow analysis (PFA) using high resolution manometry with impedance (HRMI) with AIMplot software is a method for objective interpretation of pharyngeal and upper esophageal sphincter (UES) pressures and bolus flow patterns during swallowing. This study aimed to observe alterations in PFA metrics in the event of preswallow pharyngeal bolus presence as seen on videofluoroscopy (VFSS). Methods. Swallows from 40 broad dysphagia patients and 8 controls were recorded with a HRMI catheter during simultaneous VFSS. Evidence of bolus presence and level reached prior to pharyngeal swallow onset was recorded. AIMPlot software derived automated PFA functional metrics. Results. Patients with bolus movement to the pyriform sinuses had a higher SRI, indicating greater swallow dysfunction. Amongst individual metrics, TNadImp to PeakP was shorter and flow interval longer in patient groups compared to controls. A higher pharyngeal mean impedance and UES mean impedance differentiated the two patient groups. Conclusions. This pilot study identifies specific altered PFA metrics in patients demonstrating preswallow pharyngeal bolus presence to the pyriform sinuses. PFA metrics may be used to guide diagnosis and treatment of patients with oropharyngeal dysphagia and track changes in swallow function over time

Pressure flow analysis in the assessment of preswallow pharyngeal bolus presence in Dysphagia

Objectives. Preswallow pharyngeal bolus presence is evident in patients with oropharyngeal dysphagia. Pressure flow analysis (PFA) using high resolution manometry with impedance (HRMI) with AIMplot software is a method for objective interpretation of pharyngeal and upper esophageal sphincter (UES) pressures and bolus flow patterns during swallowing. This study aimed to observe alterations in PFA metrics in the event of preswallow pharyngeal bolus presence as seen on videofluoroscopy (VFSS). Methods. Swallows from 40 broad dysphagia patients and 8 controls were recorded with a HRMI catheter during simultaneous VFSS. Evidence of bolus presence and level reached prior to pharyngeal swallow onset was recorded. AIMPlot software derived automated PFA functional metrics. Results. Patients with bolus movement to the pyriform sinuses had a higher SRI, indicating greater swallow dysfunction. Amongst individual metrics, TNadImp to PeakP was shorter and flow interval longer in patient groups compared to controls. A higher pharyngeal mean impedance and UES mean impedance differentiated the two patient groups. Conclusions. This pilot study identifies specific altered PFA metrics in patients demonstrating preswallow pharyngeal bolus presence to the pyriform sinuses. PFA metrics may be used to guide diagnosis and treatment of patients with oropharyngeal dysphagia and track changes in swallow function over time.status: publishe

Pharyngeal swallow function in children with suspected aspiration: objective assessment using automated impedance manometry (AIM)

AIM: To apply a new method, pharyngeal automated impedance manometry (AIM), as an objective assessment tool of swallow function relevant to aspiration in a cohort of pediatric patients with dysphagia. Methods: We studied 20 children (mean age 6yrs (5mo-13.4yrs)) referred for videofluoroscopy to assess aspiration risk with simultaneous manometry-impedance. Fluoroscopic evidence of aspiration was scored using a validated aspiration-penetration score (PAS). Swallowing of 5ml and/or 10ml saline boluses was recorded with a solid state pressure-impedance catheter. AIMplot software was used to derive the swallow risk index (SRI) and other functional variables (Omari et al 2011): peak pressure, pressure at nadir impedance, time from nadir impedance to peak pressure, the interval of impedance drop in the distal pharynx (flow interval, UES relaxation interval, nadir UES pressure, UES intrabolus pressure and UES resistance. In addition UES nadir impedance was measured as a correlate of UES diameter and the integrated ratio of nadir impedance to impedance was measured as a marker of post swallow residue. Data for all recorded liquid swallows were averaged for each individual. Non-parametric grouped data are presented as medians [IQrange] or as mean±standard deviation and compared using Mann-Whitney Rank Sum Test. For multiple comparisons Kruskal-Wallis ANOVA on ranks with pair-wise multiple analysis procedures (Dunn's method) was used. Correlation was determined using a Spearman Rank Order Correlation. Results: Six of twenty children presented with deglutitive aspiration on videofluoroscopy. Of 58 liquid swallows analysed, in 9 aspiration was observed. Multiple logistic regression identified longer flow interval (p<0.05) and higher SRI (p<0.05) and increased pressure in the UES during maximal bolus flow (p<0.05) as the dominant risk variables predictive of aspiration in children. Each of these non-radiologically derived pressure-flow variables correlated with higher aspiration scores on videofluoroscopy (p<0.01). Conclusions: We present novel, preliminary findings in children with deglutitive aspiration suggesting that pharyngeal AIM can non-radiologically detect alterations in pressure-flow characteristics of swallowing that predispose to aspiration risk.status: publishe