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Effect of Body Position on Pharyngeal Swallowing Pressures Using High-Resolution Manometry

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Abstract

The effect of body position and gravitational pull on the complex pressure-driven process of pharyngeal swallowing remains unknown. Using high-resolution manometry (HRM), this study aims to identify positional adaptations of pharyngeal physiology by evaluating swallowing pressure patterns in a series of inverted body positions. Ten healthy adults each underwent swallowing tasks with pharyngeal HRM at six body positions using an inversion table (0°[upright], 45°, 90°[supine], 110°, 135°, and 180°[fully inverted]). Repeated measures ANOVA was used to assess impact of position on pressure parameters, and pharyngeal-UES pressure gradients translate. Velopharyngeal pressures varied by position (P < 0.001), with significantly higher pressures generated with inversion ≥90°, compared with upright and 45°. Change in position did not significantly affect common mesopharyngeal pressures or swallowing pressure durations. UES valving mechanisms were preserved during inversion, with subtle variations observed in integral pressures (P = 0.011). Pharyngeal-UES pressure gradients changed with position (P < 0.01), increasing with inversion > 90° compared to upright and 45°. Mechanisms of deglutition may differ with position and relative direction of gravity, particularly when at > 45° inclination. Increased palatal pressure is generated in the upside-down position to achieve nasopharyngeal closure and prevent regurgitation. While other classically measured pressures may not consistently differ with positioning, many individuals exhibit adaptations in pressure gradients when inverted, likely due to a combination of changes in pharyngeal driving force and UES opening mechanisms. Identification of these changes, relative to position, further builds on our understanding of the adaptability of the pharyngeal swallowing system.

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Acknowledgements

We would like to thank Glen Leverson, PhD, biostatistician, for his consultation on statistical analysis and Kayla Foster, BA, for her assistance in manuscript preparation.

Funding

This study and its authors were supported by the National Institutes of Health Grants DC011130, T32 DC009401 (S.P.R), and T32 GM007507 (C.A.J).

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Authors and Affiliations

  1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA

    Sarah P. Rosen, Suzan M. Abdelhalim, Corinne A. Jones & Timothy M. McCulloch

  2. Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA

    Corinne A. Jones & Timothy M. McCulloch

  3. Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA

    Corinne A. Jones

  4. University of Wisconsin-Madison, Box 7375, Clinical Science Center – H4, 600 Highland Ave, Madison, WI, 53792-7375, USA

    Timothy M. McCulloch

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  1. Sarah P. Rosen
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  4. Timothy M. McCulloch
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Correspondence to Timothy M. McCulloch.

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Presentation of Manuscript Contents 97th Annual Meeting of the American Broncho-Esophagological Association, COSM, San Diego, CA, on April 26, 2017.

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Rosen, S.P., Abdelhalim, S.M., Jones, C.A. et al. Effect of Body Position on Pharyngeal Swallowing Pressures Using High-Resolution Manometry. Dysphagia 33, 389–398 (2018). https://doi.org/10.1007/s00455-017-9866-3

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  • DOI: https://doi.org/10.1007/s00455-017-9866-3

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