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High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group

Abstract

High-resolution manometry has traditionally been utilized in gastroenterology diagnostic clinical and research applications. Recently, it is also finding new and important applications in speech pathology and laryngology practices. A High-Resolution Pharyngeal Manometry International Working Group was formed as a grass roots effort to establish a consensus on methodology, protocol, and outcome metrics for high-resolution pharyngeal manometry (HRPM) with consideration of impedance as an adjunct modality. The Working Group undertook three tasks (1) survey what experts were currently doing in their clinical and/or research practice; (2) perform a review of the literature underpinning the value of particular HRPM metrics for understanding swallowing physiology and pathophysiology; and (3) establish a core outcomes set of HRPM metrics via a Delphi consensus process. Expert survey results were used to create a recommended HRPM protocol addressing system configuration, catheter insertion, and bolus administration. Ninety two articles were included in the final literature review resulting in categorization of 22 HRPM-impedance metrics into three classes: pharyngeal lumen occlusive pressures, hypopharyngeal intrabolus pressures, and upper esophageal sphincter (UES) function. A stable Delphi consensus was achieved for 8 HRPM-Impedance metrics: pharyngeal contractile integral (CI), velopharyngeal CI, hypopharyngeal CI, hypopharyngeal pressure at nadir impedance, UES integrated relaxation pressure, relaxation time, and maximum admittance. While some important unanswered questions remain, our work represents the first step in standardization of high-resolution pharyngeal manometry acquisition, measurement, and reporting. This could potentially inform future proposals for an HRPM-based classification system specifically for pharyngeal swallowing disorders.

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Acknowledgements

Additional High-Resolution Pharyngeal Manometry International Working Group Members: Jacqui Allen, University of Auckland; Lee Askt, Johns Hopkins University; Peter Belafsky, University of California, Davis; Giselle Carnaby, University of Central Florida; Charles Cock, Flinders University; Michael Crary, University of Central Florida; Kate Davidson, Medical University of South Carolina; Sebastian Doeltgen, Flinders University; Kathleen Huber, University of Wisconsin; Maggie-Lee Huckabee, University of Canterbury; Ianessa Humbert, University of Florida; Jan Lewin, MD Anderson Cancer Center; Phoebe Macrae, University of Canterbury; Bonnie Martin-Harris, Northwestern University; Nancy McCulloch, Emory University; Timothy McCulloch, University of Wisconsin; Barbara Messing, Greater Baltimore Medical Center; Anna Miles, University of Auckland; Joseph Murray, Veterans Administration Hospital, Ann Arbor; Jessica Pisegna, Boston Medical Center; Gregory Postma, Medical College of Georgia; Michal Szczesniak, University of New South Wales.

Funding

Medtronic (educational funding), Medical University of South Carolina Department of Otolaryngology – Head and Neck Surgery.

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Correspondence to Ashli O’Rourke.

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Conflict of interest

Taher Omari declares that he is a co-inventor of a relevant patent (AU2011301768 Patentee: Women’s and Children’s Health Network Incorporated). Michelle Ciucci declares that she has no conflict of interest. Kristin Gozdzikowska declares that she has no conflict of interest. Esther Hernández declares that she has no conflict of interest. Katherine Hutcheson declares that she has a travel stipend from Medtronic Inc. Corinne Jones declares that she has no conflict of interest. Julia Maclean declares that she has no conflict of interest. Nogah Nativ-Zeltzer declares that she has no conflict of interest. Emily Plowman declares that she has relevant funding through National Institute of Neurological Disorders and Stroke (1R01 NS100859-01). Nicole Rogus-Pulia declares that she has no conflict of interest. Nathalie Rommel declares that she is a co-inventor of a relevant patent (AU2011301768 Patentee: Women’s and Children’s Health Network Incorporated). Ashli O’Rourke declares she is a Consultant for Medtronic Inc.

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Omari, T.I., Ciucci, M., Gozdzikowska, K. et al. High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group. Dysphagia (2019). https://doi.org/10.1007/s00455-019-10023-y

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Keywords

  • Deglutition
  • Deglutition disorders
  • Dysphagia
  • High-resolution manometry
  • Intraluminal impedance
  • Pharynx