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Dysphagia

, Volume 32, Issue 5, pp 657–662 | Cite as

High-Resolution Manometry Evaluation of Pressures at the Pharyngo-upper Esophageal Area in Patients with Oropharyngeal Dysphagia Due to Vagal Paralysis

  • Bruno Rezende Pinna
  • Fernando A. M. Herbella
  • Noemi de Biase
  • Thays C. G. Vaiano
  • Marco G. Patti
Original Article
  • 431 Downloads

Abstract

The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus in patients with oropharyngeal dysphagia is still not entirely understood. High-resolution manometry (HRM) was recently added to the armamentarium for the study of this area. This study aims to describe HRM findings in patients with vagal paralysis. Sixteen patients (mean age 54 years, 69% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the UES and at the topography of the velopharynx and epiglottis were recorded. (1) UES relaxation is compromised in a minority of patients, (2) epiglottis pressure does not follow a specific pattern, (3) vellum is hypotonic in half of the patients, (4) dysphagia is related to a low pharyngeal pressure, not to a flow obstruction at the level of the UES, and (5) aspiration is related to low pressures at the level of the UES and epiglottis and higher pressures at the level of the vellum. Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed toward improvement in the oropharyngeal motility not at the UES.

Keywords

Upper esophageal sphincter Pharynx Dysphagia Oropharyngeal dysphagia High-resolution manometry Deglutition Deglutition disorders 

Notes

Acknowledgements

We are indebted to Ms. Vanessa Tuxen for her invaluable assistance with the esophageal tests.

Author’s contribution

BRP: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, final approval of the version to be published. FAMH: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, final approval of the version to be published. NB: conception and design, review for intellectual content, final approval of the version to be published. TCGV: review for intellectual content, final approval of the version to be published. MGP: review for intellectual content, final approval of the version to be published.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Bruno Rezende Pinna
    • 1
  • Fernando A. M. Herbella
    • 2
  • Noemi de Biase
    • 1
  • Thays C. G. Vaiano
    • 3
  • Marco G. Patti
    • 4
  1. 1.Department of Ear, Nose and Throat, Escola Paulista de MedicinaFederal University of Sao PauloSao PauloBrazil
  2. 2.Department of Surgery, Escola Paulista de MedicinaFederal University of Sao PauloSao PauloBrazil
  3. 3.Speech-Language Pathology and Audiology Department, Escola Paulista de MedicinaFederal University of Sao PauloSao PauloBrazil
  4. 4.Department of SurgeryUniversity of North CarolinaChapel HillUSA

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