Dysphagia

, Volume 27, Issue 3, pp 418–426

High-Resolution Manometry of Pharyngeal Swallow Pressure Events Associated with Effortful Swallow and the Mendelsohn Maneuver

  • Matthew R. Hoffman
  • Jason D. Mielens
  • Michelle R. Ciucci
  • Corinne A. Jones
  • Jack J. Jiang
  • Timothy M. McCulloch
Original Article

Abstract

Effortful swallow and the Mendelsohn maneuver are two common strategies to improve disordered swallowing. We used high-resolution manometry (HRM) to quantify the effects of these maneuvers on pressure and timing characteristics. Fourteen normal subjects swallowed multiple, 5-ml water boluses using three techniques: normal swallow, effortful swallow, and the Mendelsohn maneuver. Maximum pressure, rate, duration, area integral, and line integral were determined for the velopharynx and tongue base. Minimum pressure, duration of pressure-related change, duration of nadir pressure, maximum preopening and postclosure pressure, area integral, and line integral were recorded for the upper esophageal sphincter (UES). Area and line integrals of the velopharyngeal pressure curve significantly increased with the Mendelsohn maneuver; the line integral increased with the effortful swallow. Preopening UES pressure decreased significantly for the Mendelsohn, while postclosure pressure tended to increase insignificantly for both maneuvers. UES area and line integrals as well as nadir UES pressure duration increased with both maneuvers. Maneuver-dependent changes were observed primarily at the velopharynx and UES. These regions are critical to safe swallowing, as the velopharynx provides positive pressure at the bolus tail while the UES allows a bolus to enter the esophagus without risk of regurgitation. Integrals were more responsive than maximum pressure or duration and should be investigated further.

Keywords

Pharyngeal pressure Swallowing maneuver High-resolution manometry Deglutition Deglutition disorders 

References

  1. 1.
    Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54:171–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed; 1998.Google Scholar
  3. 3.
    Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14:67–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Huckabee ML, Butler SG, Barclay M, Jit S. Submental surface electromyographic measurement and pharyngeal pressures during normal and effortful swallowing. Arch Phys Med Rehabil. 2005;86:2144–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Logemann JA, Kahrilas PJ. Relearning to swallow after stroke—application of maneuvers and indirect biofeedback: a case study. Neurology. 1990;40:1136–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Ding R, Larson CR, Logemann JA, Rademaker AW. Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: normal and during the Mendelsohn manuever. Dysphagia. 2002;17:1–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Boden K, Hallgren A, Witt Hedstrom H. Effects of three different swallow maneuvers analyzed by videomanometry. Acta Radiol. 2006;47:628–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Bulow M, Olsson R, Ekkberg O. Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction. Dysphagia. 2002;17:197–201.PubMedCrossRefGoogle Scholar
  10. 10.
    Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260:G450–6.PubMedGoogle Scholar
  11. 11.
    Logemann JA, Kahrilas PJ, Kobara M, Vakil NB. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil. 1989;70:767–71.PubMedGoogle Scholar
  12. 12.
    Kelly JH. Use of manometry in the evaluation of dysphagia. Otolaryngol Head Neck Surg. 1997;116:355–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut. 2008;57:405–23.PubMedCrossRefGoogle Scholar
  14. 14.
    McCulloch T, 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(6):369–76.PubMedGoogle Scholar
  15. 15.
    Takasaki K, Umeki H, Kumagami H, Takahashi H. Influence of head rotation on upper esophageal sphincter pressure evaluated by high-resolution manometry system. Otolaryngol Head Neck Surg. 2010;142:214–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Hoffman MR, Ciucci MR, Mielens JD, Jiang JJ, McCulloch TM. Pharyngeal swallow adaptations to bolus volume measured with high resolution manometry. Laryngoscope. 2010;120(12):2367–73.PubMedCrossRefGoogle Scholar
  17. 17.
    Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res. 2008;51:1072–87.PubMedCrossRefGoogle Scholar
  18. 18.
    Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;12:400–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Langmore SE, Miller RM. Behavioral treatment for adults with oropharyngeal dysphagia. Arch Phys Med Rehabil. 1994;75:1154–60.PubMedCrossRefGoogle Scholar
  20. 20.
    Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51:199–212.PubMedCrossRefGoogle Scholar
  21. 21.
    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 Gastrointest Liver Physiol. 2006;291(3):G525–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck. 1993;15:419–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Ali GN, Cook IJ, Laundl TM, Wallace KL, de Carle DJ. Influence of altered tongue contour and position on deglutitive pharyngeal and UES function. Am J Physiol. 1997;273:G1071–6.PubMedGoogle Scholar
  24. 24.
    Witte U, Huckabee ML, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants. Arch Phys Med Rehabil. 2008;89:822–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Matthew R. Hoffman
    • 1
  • Jason D. Mielens
    • 1
  • Michelle R. Ciucci
    • 1
    • 2
  • Corinne A. Jones
    • 1
  • Jack J. Jiang
    • 1
  • Timothy M. McCulloch
    • 1
  1. 1.Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Communicative Disorders, College of Letters & ScienceUniversity of WisconsinMadisonUSA

Personalised recommendations