Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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


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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    International High Resolution Manometry Working, G. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74. https://doi.org/10.1111/nmo.12477.

  2. 2.

    Williamson PR, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13:132.

  3. 3.

    Guiu Hernandez E, Gozdzikowska K, Apperley O, Huckabee ML. Effect of topical nasal anesthetic on swallowing in healthy adults: a double-blind, high-resolution manometry study. Laryngoscope. 2017;128(6):1335–9. https://doi.org/10.1002/lary.26996.

  4. 4.

    Fife TA, et al. Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients. Ann Otol Rhinol Laryngol. 2015;124:206–11.

  5. 5.

    Lester S, et al. The effects of topical anesthetic on swallowing during nasoendoscopy. Laryngoscope. 2013;123:1704–8.

  6. 6.

    O’Dea MB, et al. Effect of lidocaine on swallowing during FEES in patients with dysphagia. Ann Otol Rhinol Laryngol. 2015;124:537–44.

  7. 7.

    Johnson PE, Belafsky PC, Postma GN. Topical nasal anesthesia and laryngopharyngeal sensory testing: a prospective, double-blind crossover study. Ann Otol Rhinol Laryngol. 2003;112:14–6.

  8. 8.

    Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Berlin: Springer; 2016.

  9. 9.

    Knigge MA, Thibeault S, McCulloch TM. Implementation of high-resolution manometry in the clinical practice of speech language pathology. Dysphagia. 2014;29:2–16. https://doi.org/10.1007/s00455-013-9494-5.

  10. 10.

    Cock C, Omari T. Diagnosis of swallowing disorders: how we interpret pharyngeal manometry. Curr Gastroenterol Rep. 2017;19:11. https://doi.org/10.1007/s11894-017-0552-2.

  11. 11.

    Ferris L, et al. Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter. Laryngoscope. 2017;28(6):1328–34. https://doi.org/10.1002/lary.26820.

  12. 12.

    Schar M, et al. Pathophysiology of swallowing following oropharyngeal surgery for obstructive sleep apnea syndrome. Neurogastroenterol Motil. 2017;30(5):e13277. https://doi.org/10.1111/nmo.13277.

  13. 13.

    Singendonk M, et al. Reliability of an online analysis platform for pharyngeal high-resolution impedance manometry (HRIM) recordings. Speech Lang Hear. 2018;154:S983. https://doi.org/10.1016/S0016-5085(18)33298-0.

  14. 14.

    Jiao H, et al. A human model of restricted upper esophageal sphincter opening and its pharyngeal and UES deglutitive pressure phenomena. Am J Physiol. 2016;311:G84–90. https://doi.org/10.1152/ajpgi.00145.2016.

  15. 15.

    Nativ-Zeltzer N, Logemann JA, Zecker SG, Kahrilas PJ. Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography: a normative study of younger and older adults. Neurogastroenterol Motil. 2016;28:721–31. https://doi.org/10.1111/nmo.12769.

  16. 16.

    O’Rourke A, Humphries K, Lazar A, Martin-Harris B. The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment. Neurogastroenterol Motil. 2017;29:e131444. https://doi.org/10.1111/nmo.13144.

  17. 17.

    Walczak CC, Jones CA, McCulloch TM. Pharyngeal pressure and timing during bolus transit. Dysphagia. 2017;32:104–14. https://doi.org/10.1007/s00455-016-9743-5.

  18. 18.

    Rosen SP, Abdelhalim SM, Jones CA, McCulloch TM. Effect of body position on pharyngeal swallowing pressures using high-resolution manometry. Dysphagia. 2017;32:835–6. https://doi.org/10.1007/s00455-017-9866-3.

  19. 19.

    Omari TI, Dejaeger E, Tack J, Van Beckevoort D, Rommel N. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia. 2013;28:146–52. https://doi.org/10.1007/s00455-012-9423-z.

  20. 20.

    Lippert D, et al. Preliminary evaluation of functional swallow after total laryngectomy using high-resolution manometry. Ann Otol Rhinol Laryngol. 2016;125:541–9. https://doi.org/10.1177/0003489416629978.

  21. 21.

    Omari TI, et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140:1454–63. https://doi.org/10.1053/j.gastro.2011.02.051.

  22. 22.

    Cock C, et al. Maximum upper esophageal sphincter (UES) admittance: a non-specific marker of UES dysfunction. Neurogastroenterol Motil. 2016;28:225–33. https://doi.org/10.1111/nmo.12714.

  23. 23.

    Jones CA, Ciucci MR. Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. J Parkinson’s Dis. 2016;6:197–208. https://doi.org/10.3233/JPD-150687.

  24. 24.

    Park C-H, et al. Quantitative analysis of swallowing function between dysphagia patients and healthy subjects using high-resolution manometry. Ann Rehabil Med. 2017;41:776–85.

  25. 25.

    Park D, Oh Y, Ryu JS. Findings of abnormal videofluoroscopic swallowing study identified by high-resolution manometry parameters. Arch Phys Med Rehabil. 2016;97:421–8. https://doi.org/10.1016/j.apmr.2015.10.084.

  26. 26.

    Park C-H, et al. Ability of high-resolution manometry to determine feeding method and to predict aspiration pneumonia in patients with dysphagia. Am J Gastroenterol. 2017;112:1074. https://doi.org/10.1038/ajg.2017.81.

  27. 27.

    Kritas S, Dejaeger E, Tack J, Omari T, Rommel N. Objective prediction of pharyngeal swallow dysfunction in dysphagia through artificial neural network modeling. Neurogastroenterol Motil. 2016;28:336–44. https://doi.org/10.1111/nmo.12730.

  28. 28.

    Doeltgen SH, Ong E, Scholten I, Cock C, Omari T. Biomechanical quantification of mendelsohn maneuver and effortful swallowing on pharyngoesophageal function. Otolaryngol Head Neck Surg. 2017;157:816–23. https://doi.org/10.1177/0194599817708173.

  29. 29.

    Cook IJ, et al. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103:1229–35.

  30. 30.

    Ali GN, Wallace KL, Laundl TM, Hunt DR, Cook IJ. Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia. Dysphagia. 1997;12:133–9.

  31. 31.

    Mason RJ, et al. Pharyngeal swallowing disorders: selection for and outcome after myotomy. Ann Surg. 1998;228:598.

  32. 32.

    Knigge MA, Thibeault SL. Swallowing outcomes after cricopharyngeal myotomy: a systematic review. Head Neck. 2018;40:203–12.

  33. 33.

    Zhang T, et al. Biomechanics of pharyngeal deglutitive function following total laryngectomy. Otolaryngol Head Neck Surg. 2016;155:295–302. https://doi.org/10.1177/0194599816639249.

  34. 34.

    Omari TI, et al. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Clin Gastroenterol Hepatol. 2011;9:862–7. https://doi.org/10.1016/j.cgh.2011.05.026.

  35. 35.

    Doeltgen SH, Omari TI, Savilampi J. Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure impedance analysis. Am J Physiol. 2016;310:G1176–82. https://doi.org/10.1152/ajpgi.00138.2016.

  36. 36.

    Savilampi J, Omari T, Magnuson A, Ahlstrand R. Effects of remifentanil on pharyngeal swallowing: a double blind randomised cross-over study in healthy volunteers. Eur J Anaesthesiol. 2016;33:622–30. https://doi.org/10.1097/EJA.0000000000000461.

  37. 37.

    Szczesniak M, Wu P, Maclean J, Omari T, Cook I. The critical importance of pharyngeal contractile forces on the validity of intrabolus pressure as a predictor of impaired pharyngo-esophageal junction compliance. Neurogastroenterol Motil. 2018;30:e13374. https://doi.org/10.1111/nmo.13374.

  38. 38.

    Cook IJ. Combined pharyngeal impedance-manometry: has it finally come of age? Clin Gastroenterol Hepatol. 2011;9:813–5.

  39. 39.

    Szczesniak M, et al. Inter-rater reliability and validity of automated impedance manometry analysis and fluoroscopy in dysphagic patients after head and neck cancer radiotherapy. Neurogastroenterol Motil. 2015;27:1183–9. https://doi.org/10.1111/nmo.12610.

  40. 40.

    Omari TI, et al. The reliability of pharyngeal high resolution manometry with impedance for derivation of measures of swallowing function in healthy volunteers. Int J Otolaryngol. 2016;2016:1. https://doi.org/10.1155/2016/2718482.

  41. 41.

    Omari TI, et al. A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol. 2011;106:1796–802. https://doi.org/10.1038/ajg.2011.143.

  42. 42.

    Park D, et al. Normal contractile algorithm of swallowing related muscles revealed by needle EMG and its comparison to videofluoroscopic swallowing study and high resolution manometry studies: a preliminary study. J Electromyogr Kinesiol. 2017;36:81–9. https://doi.org/10.1016/j.jelekin.2017.07.007.

  43. 43.

    Jones CA, Hammer MJ, Hoffman MR, McCulloch TM. Quantifying contributions of the cricopharyngeus to upper esophageal sphincter pressure changes by means of intramuscular electromyography and high-resolution manometry. Ann Otol Rhinol Laryngol. 2014;123:174–82. https://doi.org/10.1177/0003489414522975.

  44. 44.

    Omari TI, et al. Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening. Front Syst Neurosci. 2015;8:241. https://doi.org/10.3389/fnsys.2014.00241.

  45. 45.

    Omari TI, et al. Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening. Am J Physiol. 2016;310:G359–66. https://doi.org/10.1152/ajpgi.00388.2015.

  46. 46.

    Cock C, Jones CA, Hammer MJ, Omari TI, McCulloch TM. Modulation of upper esophageal sphincter (UES) relaxation and opening during volume swallowing. Dysphagia. 2017;32:216–24. https://doi.org/10.1007/s00455-016-9744-4.

  47. 47.

    Lee T, et al. Failed deglutitive upper esophageal sphincter relaxation is a risk factor for aspiration in stroke patients with oropharyngeal dysphagia. J Neurogastroenterol Motil. 2017;23:34–40. https://doi.org/10.5056/jnm16028.

  48. 48.

    Rommel N, et al. Objective assessment of swallow function in children with suspected aspiration using pharyngeal automated impedance manometry. J Pediatr Gastroenterol Nutr. 2014;58:789–94. https://doi.org/10.1097/MPG.0000000000000337.

  49. 49.

    Ghosh SK, Pandolfino JE, Zhang Q, Jarosz A, Kahrilas PJ. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol. 2006;291:G525–31. https://doi.org/10.1152/ajpgi.00081.2006.

  50. 50.

    Ghosh SK, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol. 2007;293:G878–85.

  51. 51.

    Kahrilas P, Dodds W, Dent J, Logemann J, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95:52–62.

  52. 52.

    Weijenborg PW, Kessing BF, Smout AJ, Bredenoord AJ. Normal values for solid-state esophageal high-resolution manometry in a European population; an overview of all current metrics. Neurogastroenterol Motil. 2014;26:654–9. https://doi.org/10.1111/nmo.12314.

  53. 53.

    Omari TI, et al. Upper esophageal sphincter impedance as a marker of sphincter opening diameter. Am J Physiol. 2012;302:G909–13. https://doi.org/10.1152/ajpgi.00473.2011.

  54. 54.

    Ferris L, et al. Pressure-flow analysis for the assessment of pediatric oropharyngeal dysphagia. J Pediatr. 2016;177:279–285-e271. https://doi.org/10.1016/j.jpeds.2016.06.032.

  55. 55.

    Omari T, et al. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol Motil. 2014;26:59–68. https://doi.org/10.1111/nmo.12224.

  56. 56.

    Zhang T, et al. Esophageal dysmotility in patients following total laryngectomy. Otolaryngol Head Neck Surg. 2017;158(2):323–30. https://doi.org/10.1177/0194599817736507.

  57. 57.

    McCulloch TM, Hoffman MR, Ciucci MR. High resolution manometry of pharyngeal swallow pressure events associated with head turn and chin tuck. Ann Otol Rhinol Laryngol. 2010;119:369–76.

  58. 58.

    Hoffman MR, Ciucci MR, Mielens JD, Jiang JJ, McCulloch TM. Pharyngeal swallow adaptations to bolus volume measured with high resolution manometry. Laryngoscope. 2010;120:2367–73. https://doi.org/10.1002/lary.21150.

  59. 59.

    Omari T, Dejaeger E, Tack J, Vanbeckevoort D, Rommel N. An impedance-manometry based method for non-radiological detection of pharyngeal postswallow residue. Neurogastroenterol Motil. 2012;24:e277–84. https://doi.org/10.1111/j.1365-2982.2012.01931.x.

  60. 60.

    Omari T, Kritas S, Cock C. New insights into pharyngo-esophageal bolus transport revealed by pressure-impedance measurement. Neurogastroenterol Motil. 2012;24:e549–56. https://doi.org/10.1111/nmo.12007.

  61. 61.

    Silva LC, et al. Anatomophysiology of the pharyngo-upper esophageal area in light of high-resolution manometry. J Gastrointest Surg. 2013;17:2033–8. https://doi.org/10.1007/s11605-013-2358-3.

  62. 62.

    Hammer MJ, Jones CA, Mielens JD, Kim CH, McCulloch TM. Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography. Dysphagia. 2014;29:564–70. https://doi.org/10.1007/s00455-014-9545-6.

  63. 63.

    Kim CK, et al. Effects of head rotation and head tilt on pharyngeal pressure events using high resolution manometry. Ann Rehabil Med. 2015;39:425–31. https://doi.org/10.5535/arm.2015.39.3.425.

  64. 64.

    Rosen SP, Jones CA, McCulloch TM. Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry. Laryngoscope. 2017;127:1989–95. https://doi.org/10.1002/lary.26483.

  65. 65.

    Balasubramanian G, et al. Characterization of pharyngeal peristaltic pressure variability during volitional swallowing in healthy individuals. Neurogastroenterol Motil. 2017;29:e13119. https://doi.org/10.1111/nmo.13119.

  66. 66.

    Lin T, et al. Effect of bolus volume on pharyngeal swallowing assessed by high-resolution manometry. Physiol Behav. 2014;128:46–51. https://doi.org/10.1016/j.physbeh.2014.01.030.

  67. 67.

    Omari TI, et al. Assessment of intraluminal impedance for the detection of pharyngeal bolus flow during swallowing in healthy adults. Am J Physiol. 2006;290:G183–8. https://doi.org/10.1152/ajpgi.00011.2005.

  68. 68.

    Takasaki K, et al. Investigation of pharyngeal swallowing function using high-resolution manometry. Laryngoscope. 2008;118:1729–32. https://doi.org/10.1097/MLG.0b013e31817dfd02.

  69. 69.

    Mielens JD, Hoffman MR, Ciucci MR, McCulloch TM, Jiang JJ. Application of classification models to pharyngeal high-resolution manometry. J Speech Lang Hear Res. 2012;55:892–902. https://doi.org/10.1044/1092-4388(2011/11-0088).

  70. 70.

    Geng Z, Hoffman MR, Jones CA, McCulloch TM, Jiang JJ. Three-dimensional analysis of pharyngeal high-resolution manometry data. Laryngoscope. 2013;123:1746–53. https://doi.org/10.1002/lary.23987.

  71. 71.

    Ferris L, et al. Pressure flow analysis in the assessment of preswallow pharyngeal bolus presence in dysphagia. Int J Otolaryngol. 2015;2015:1–6. https://doi.org/10.1155/2015/764709.

  72. 72.

    Noll L, Rommel N, Davidson G, Omari T. Pharyngeal flow interval: a novel impedance-based parameter correlating with aspiration. Neurogastroenterol Motil. 2011;23:551. https://doi.org/10.1111/j.1365-2982.2010.01634.x.

  73. 73.

    Hoffman MR, et al. Artificial neural network classification of pharyngeal high-resolution manometry with impedance data. Laryngoscope. 2013;123:713–20. https://doi.org/10.1002/lary.23655.

  74. 74.

    Hoffman MR, et al. Classification of high-resolution manometry data according to videofluoroscopic parameters using pattern recognition. Otolaryngol Head Neck Surg. 2013;149:126–33. https://doi.org/10.1177/0194599813489506.

  75. 75.

    Yoon KJ, Park JH, Park JH, Jung IS. Videofluoroscopic and manometric evaluation of pharyngeal and upper esophageal sphincter function during swallowing. J Neurogastroenterol Motil. 2014;20:352–61. https://doi.org/10.5056/jnm14021.

  76. 76.

    Lan Y, et al. Biomechanical changes in the pharynx and upper esophageal sphincter after modified balloon dilatation in brainstem stroke patients with dysphagia. Neurogastroenterol Motil. 2013;25:e821–9. https://doi.org/10.1111/nmo.12209.

  77. 77.

    Takasaki K, Umeki H, Hara M, Kumagami H, Takahashi H. Influence of effortful swallow on pharyngeal pressure: evaluation using a high-resolution manometry. Otolaryngol Head Neck Surg. 2011;144:16–20. https://doi.org/10.1177/0194599810390885.

  78. 78.

    Hoffman MR, et al. High resolution manometry of pharyngeal swallow pressure events associated with effortful swallow and the Mendelsohn maneuver. Dysphagia. 2012;27:418–26. https://doi.org/10.1007/s00455-011-9385-6.

  79. 79.

    Derrey S, et al. Impact of deep brain stimulation on pharyngo-esophageal motility: a randomized cross-over study. Neurogastroenterol Motil. 2015;27:1214–22. https://doi.org/10.1111/nmo.12607.

  80. 80.

    Jungheim M, Schubert C, Miller S, Ptok M. Swallowing function after continuous neuromuscular electrical stimulation of the submandibular region evaluated by high-resolution manometry. Dysphagia. 2017;32:501–8. https://doi.org/10.1007/s00455-017-9791-5.

  81. 81.

    Doeltgen SH, Rigney L, Cock C, Omari T. Effects of cortical anodal transcranial direct current stimulation on swallowing biomechanics. Neurogastroenterol Motil. 2018;30:13434. https://doi.org/10.1111/nmo.13434.

  82. 82.

    Jones CA, et al. Reliability of an automated high-resolution manometry analysis program across expert users, novice users, and speech-language pathologists. J Speech Lang Hear Res. 2014;57:831–6. https://doi.org/10.1044/2014_JSLHR-S-13-0101.

  83. 83.

    Lee TH, et al. High-resolution manometry: reliability of automated analysis of upper esophageal sphincter relaxation parameters. Turk J Gastroenterol. 2014;25:473–80. https://doi.org/10.5152/tjg.2014.8021.

  84. 84.

    Jungheim M, et al. Calculation of upper esophageal sphincter restitution time from high resolution manometry data using machine learning. Physiol Behav. 2016;165:413–24. https://doi.org/10.1016/j.physbeh.2016.08.005.

  85. 85.

    Kern MK, et al. Pharyngeal peristaltic pressure variability, operational range, and functional reserve. Am J Physiol. 2017;312:G516–25. https://doi.org/10.1152/ajpgi.00382.2016.

  86. 86.

    Williams RB, Pal A, Brasseur JG, Cook IJ. Space–time pressure structure of pharyngo-esophageal segment during swallowing. Am J Physiol. 2001;281:G1290–300.

  87. 87.

    Plowman EK, et al. Autologous myoblasts attenuate atrophy and improve tongue force in a denervated tongue model: a pilot study. Laryngoscope. 2014;124:E20–6. https://doi.org/10.1002/lary.24352.

  88. 88.

    Jones C, et al. Identification of swallowing disorders in early and mid-stage Parkinson’s disease using pattern recognition of pharyngeal high-resolution manometry data. Neurogastroenterol Motil. 2017;30(4):e13236.

  89. 89.

    Menezes MA, Herbella FA, Patti MG. High-resolution manometry evaluation of the pharynx and upper esophageal sphincter motility in patients with achalasia. J Gastrointest Surg. 2015;19:1753–7. https://doi.org/10.1007/s11605-015-2901-5.

  90. 90.

    Arenaz Búa B, Olsson R, Westin U, Rydell R. The pharyngoesophageal segment after total laryngectomy. Ann Otol Rhinol Laryngol. 2017;126:138–45. https://doi.org/10.1177/0003489416681321.

  91. 91.

    Knigge MA, Thibeault S. Relationship between tongue base region pressures and vallecular clearance. Dysphagia. 2016;31:391–7. https://doi.org/10.1007/s00455-015-9688-0.

  92. 92.

    Meyer JP, Jones CA, Walczak CC, McCulloch TM. Three-dimensional manometry of the upper esophageal sphincter in swallowing and nonswallowing tasks. Laryngoscope. 2016;126:2539–45. https://doi.org/10.1002/lary.25957.

  93. 93.

    Hutcheson KA, Hammer MJ, Rosen SP, Jones CA, McCulloch TM. Expiratory muscle strength training evaluated with simultaneous high resolution manometry and electromyography. Laryngoscope. 2017;127:797–804. https://doi.org/10.1002/lary.26397.

  94. 94.

    de Leon A, Thörn S-E, Wattwil M. High-resolution solid-state manometry of the upper and lower esophageal sphincters during anesthesia induction: a comparison between obese and non-obese patients. Anesth Analg. 2010;111:149–53. https://doi.org/10.1213/ANE.0b013e3181e1a71f.

  95. 95.

    Mielens JD, Hoffman MR, Ciucci MR, Jiang JJ, McCulloch TM. Automated analysis of pharyngeal pressure data obtained with high-resolution manometry. Dysphagia. 2011;26:3–12. https://doi.org/10.1007/s00455-010-9320-2.

  96. 96.

    Vardar R, Sweis R, Anggiansah A, Wong T, Fox M. Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry. Dis Esophagus. 2013;26:219–25. https://doi.org/10.1111/j.1442-2050.2012.01354.x.

  97. 97.

    Pinna BR, Herbella FA, de Biase N, Vaiano TC, Patti MG. High-resolution manometry evaluation of pressures at the pharyngo-upper esophageal area in patients with oropharyngeal dysphagia due to vagal paralysis. Dysphagia. 2017;32:657–62. https://doi.org/10.1007/s00455-017-9811-5.

  98. 98.

    Singendonk M, et al. Upper gastrointestinal function in morbidly obese adolescents before and 6 months after gastric banding. Obes Surg. 2017;28:1277–88. https://doi.org/10.1007/s11695-017-3000-3.

  99. 99.

    Rommel N, Davidson G, Cain T, Hebbard G, Omari T. Videomanometric evaluation of pharyngo-oesophageal dysmotility in children with velocardiofacial syndrome. J Pediatr Gastroenterol Nutr. 2008;46:87–91.

  100. 100.

    Ferris L, et al. Piecemeal deglutition and the implications for pressure impedance dysphagia assessment in pediatrics. J Pediatr Gastroenterol Nutr. 2018;67:713–9. https://doi.org/10.1097/MPG.0000000000002080.

  101. 101.

    Jones CA, et al. Methods for measuring swallowing pressure variability using high-resolution manometry. Front Appl Math Stat. 2018;4:23. https://doi.org/10.3389/fams.2018.00023.

  102. 102.

    Hernandez EG, Gozdzikowska K, Jones R, Huckabee M-L. Comparison of unidirectional and circumferential manometric measures within the pharyngoesophageal segment: an exploratory study. Eur Arch Otorhinolaryngol. 2018;275:2302–10.

  103. 103.

    Jadcherla SR, et al. Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor. Pediatr Res. 2018;84:341–7.

Download references


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.


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

Author information

Correspondence to Ashli O’Rourke.

Ethics declarations

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.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation


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