Ann Rehabil Med.  2017 Oct;41(5):776-785. 10.5535/arm.2017.41.5.776.

Quantitative Analysis of Swallowing Function Between Dysphagia Patients and Healthy Subjects Using High-Resolution Manometry

• Park CH
• Kim DK
• Lee YT
• Yi Y
• Lee JS
• Kim K
• Park JH
• Yoon KJ

• KMID: 2440804
• DOI: http://doi.org/10.5535/arm.2017.41.5.776

Abstract

OBJECTIVE
To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia.
METHODS
Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined.
RESULTS
VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia.
CONCLUSION
We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.

Keyword

Deglutition disorders; Manometry; Pharynx; Upper esophageal sphincter

MeSH Terms

Deglutition Disorders*
Deglutition*
Diagnosis
Esophageal Sphincter, Upper
Healthy Volunteers*
Humans
Manometry*
Pharynx
Relaxation
ROC Curve
Sensitivity and Specificity
Tongue

Figure

• 

  Fig. 1 Regions of interest for high-resolution manometry (HRM) procedure. UES, upper esophageal sphincter.

• 

  Fig. 2 Relationship between Dysphagia Outcome and Severity Scale (DOSS) and significant HRM parameters in study subjects. The p-values were analyzed by Pearson correlation coefficient (r). Asterisk indicates p-value of less than 0.01. HRM, high-resolution manometry; VP, velopharynx; TB, tongue base; UES, upper esophageal sphincter.

• 

  Fig. 3 The optimal threshold values of significant HRM parameters for identifying dysphagia on ROC analyses. HRM, high-resolution manometry; ROC, receiver operating curve; VP, velopharynx; TB, tongue base; UES, upper esophageal sphincter; PPV, positive predictive value; NPV, negative predictive value; CI, confidence interval.

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