Anterior-posterior distension of maximal upper esophageal sphincter opening is correlated with high-resolution cervical auscultation signal features

The pharyngoesophageal sphincter (PES) has been studied extensively using the standard three lumen esophageal catheter. Studies using this catheter are nonreproduciible because intraluminal pressure in the PES is dependent on the orientation of the catheter. This difficulty was overcome when a multiluminal catheter was developed by Winans. In this work we used a modification of this multiluminal catheter to study the PES in 6 normal patients and in 13 patients who had undergone partial laryngeal surgery. Pressure profiles in the six normal patients revealed a marked increase in intraluminal pressure in the anterior-posterior direction. This is explained by the anatomy of the cricopharyngeal muscle which does not insert in a median raphe. These readings were reliable and reproducible. The operative patients included nine subtotal supraglottic laryngectomies and four partial laryngopharyngectomies. Eight patients had a cricopharyngeal myotomy and five did not. Pre- and postoperative measurements in this series revealed a marked decrease in PES pressure in those patients who had a myotomy; however, all patients were decannulated and swallowed postoperatively without clinical evidence of aspiration. All future manometric studies of the PES should employ a multilumined catheter in order that the differential pressures in the upper esophagus are recorded.

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S118 – Study of Pharyngeal Swallowing by High-resolution Manometry

Otolaryngology ◽

10.1016/j.otohns.2008.05.291 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P116-P117

Author(s):

Kenji Takasaki ◽

Umeki Hiroshi ◽

Kaori Enatsu ◽

Fujinobu Tanaka ◽

Hidetaka Kumagami ◽

...

Keyword(s):

High Resolution ◽

Normal Values ◽

Upper Esophageal Sphincter ◽

Cervical Esophagus ◽

High Resolution Manometry ◽

Maximum Value ◽

Physiological Information ◽

Asymptomatic Adult ◽

Esophageal Sphincter ◽

Pharyngeal Swallowing

Objectives This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods 33 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above-mentioned points of pressure were also measured. Results The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid-point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively. Conclusions The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.

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