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High-Resolution Pharyngeal Manometry: Recent Developments and Future Directions

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Abstract

Purpose of Review

This review article will discuss recent developments in high-resolution pharyngeal manometry, including diagnostic applications, and proposed standard metrics and protocol, as well as its use as a therapeutic biofeedback tool.

Recent Findings

An International High-Resolution Pharyngeal Manometry (HRPM) Working Group has proposed use of three classes of HRPM metric standardization of HRPM data collection: pharyngeal lumen occlusive pressures (including pressures at the velopharynx, mesopharynx, and hypopharynx), upper esophageal sphincter (UES) function parameters (UES relaxation time and integrated relaxation pressure), and hypopharyngeal intrabolus pressure. The pharyngeal contractile integral (PhCI), in particular, has been shown to have promise as an indicator of the presence of swallowing impairment. Complex biomechanical relationships between pharyngeal drive and UES contractility have been identified, necessitating that clinicians take the entire system into account when assessing pharyngeal swallowing deficits. HRPM biofeedback therapy is an emerging form of dysphagia therapy which provides visual feedback of swallowing performance to patients in real time.

Summary

HRPM is a non-radiologic clinical tool that provides objective measures of pharyngeal swallowing pressures and timing. Development of normative values remains an ongoing effort, with only a few studies available that provide normal values for the standard metrics recently proposed by the HRPM International Working Group. HRPM biofeedback dysphagia therapy is safe and well-tolerated, and has anecdotal evidence supporting its use.

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Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Rutledge Avenue, SC, 29425, Charleston, USA

    Haley Sibley, Kate Davidson & Ashli O’Rourke

  2. Department of Rehabilitation-Acute Care, Lehigh Valley Health Network, 1200 South Cedar Crest Blvd, Allentown, PA, 18103, USA

    Kasey Miller

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Correspondence to Ashli O’Rourke.

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Conflict of Interest

Haley Sibley has nothing to disclose. Kasey Miller reports being a guest lecturer for MUSC’s Speech-Language Pathology program. Kate Davidson reports the following: salary from Medical University of South Carolina; royalties and consulting fees from Northern Speech Services for MBSImP; honorarium from Cincinnati Children’s Hospital for lecture on HRPM. Ashli O’Rourke reports personal fees from Medtronic Inc. and Laborie Medical Inc.

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All reported studies/experiments with human or animal subjects performed by the authors have previously been published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national institutional guidelines).

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Sibley, H., Miller, K., Davidson, K. et al. High-Resolution Pharyngeal Manometry: Recent Developments and Future Directions. Curr Otorhinolaryngol Rep 11, 374–380 (2023). https://doi.org/10.1007/s40136-023-00461-6

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