Findings of Abnormal Videofluoroscopic Swallowing Study Identified by High-Resolution Manometry Parameters

Objective: To identify the parameters of high-resolution manometry (HRM) with a significant correlation to abnormal findings of video-fluoroscopic swallowing study (VFSS). Design: Prospective study. Setting: Hospital rehabilitation department. Participants: Patients with dysphagia symptoms (N=40). Intervention: Participants were evaluated once using VFSS in neutral head position and evaluated twice using HRM with 5mL of thin fluid. Main Outcome Measures: HRM parameters included maximal pressure, area integral, rise time, duration of the velopharynx and tongue base, maximal pressure of pre-upper esophageal sphincter (UES), low pharynx, cricopharyngeus, minimal UES pressure, UES activity time, and nadir UES duration. HRM parameters were compared with the findings of VFSS. Receiver operating characteristic analysis was performed to obtain the cutoff value, sensitivity, and specificity of HRM parameters for the prediction of findings of VFSS. Results: The maximum pressure of the velopharynx showed a significantly positive prediction for most abnormal parameters of VFSS in the pharyngeal phase. Nadir UES pressure duration was significant for impaired laryngeal elevation, residue at pyriformis sinus, and combination of penetration and aspiration. The maximum pressure of the velopharynx <180.0 showed 100% sensitivity and 75% specificity for the presence of penetration and aspiration, and the cutoff point of 178.8 showed 86.7% sensitivity and 75% specificity for the presence of subglottic aspiration. Conclusions: This study identified significant HRM parameters that are highly specific for individual abnormalities of VFSS, suggesting the cutoff value, sensitivity, and specificity. Because HRM could inform the quantitative measurement of pharyngeal weakness, the cutoff value for HRM parameters could be used to predict aspiration in patients with pharyngeal weakness. (C) 2016 by the American Congress of Rehabilitation Medicine