Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers

Abstract

Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6±32.6 (±2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2±8.0 (±2 SD) mmHg during barium swallow and 3.8±6.2 (±2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601±248 (±2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8±142.8 (±2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2±17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.