Pressure-Flow Analysis for the Assessment of Pediatric Oropharyngeal Dysphagia
Scholten, Ingrid Maria
McCall, Lisa M
Moore, David John
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Objectives Pharyngeal High Resolution Manometry with Impedance (HRIM) was performed in a heterogeneous group of children with signs of oropharyngeal dysphagia (OPD). The aim of this study was to determine which objective pressure-impedance measures of pharyngeal swallowing function correlated with clinically assessed severity of OPD symptoms. Study Design Forty five pediatric OPD patients and 34 non-OPD controls were recruited and up to 5 liquid bolus swallows were recorded using a solid state HRIM catheter. Individual measures of pharyngeal and upper esophageal sphincter (UES) function and a Swallow Risk Index composite score were derived for each swallow, and averaged data for OPD patients were compared against those of non-OPD controls. Clinical severity of OPD symptoms and oral feeding competency was based on the validated Dysphagia Disorders Survey (DDS) and Functional Oral Intake Scale. Results Those objective measures that were markers of UES relaxation, UES opening and pharyngeal flow resistance, differentiated patients with and without OPD symptoms. Patients demonstrating abnormally high pharyngeal intra-bolus pressures and high UES resistance, markers of outflow obstruction, were most likely to have overt DDS signs and symptoms (Odds Ratio 9.24, p=0.05, and 9.7, p = 0.016, respectively). Conclusion Pharyngeal motor patterns can be recorded in children using HRIM and pharyngeal function can be objectively defined using pressure-impedance measures. Objective measurements suggest that pharyngeal dysfunction is common in children with clinical signs of OPD. A key finding of this study was evidence of markers of restricted UES opening.
This is the authors’ version of an article published in Journal of Pediatrics. The original publication is available by subscription at: http://dx.doi.org/10.1016/j.jpeds.2016.06.032 Licensed under the the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. This author accepted manuscript is made available following 12 month embargo from date of publication (1 Aug 2016) in accordance with the publisher's copyright policy.