Skip to main content

Advertisement

Log in

Manofluorography in the Evaluation of Oropharyngeal Dysphagia

  • Review Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically, partially because of various limitations of conventional manometry. Technological advancements in recent years have led to substantial improvements in manometric devises, which can now overcome many of the shortcomings of standard manometry. In parallel with this, studies examining the utility of high-resolution manometry for the evaluation of pharyngeal disorders of swallowing have begun to emerge. This review summarizes the technological developments in manometry and the existing literature on pharyngeal high-resolution manofluorography with pressure topography. The article also discusses the potential clinical value of high-resolution pharyngeal–esophageal pressure topography and suggests directions for future investigations. Studies conducted so far have shown heterogeneous approaches to utilizing high-resolution manofluorography. These studies have revealed important information regarding its diagnostic potential and researchers have devised innovative methods of measurements. However, substantial research is required to transform manofluorography into a clinically useful tool. There is a need to conduct validation studies, correlating manometric measures with structural changes in the swallow seen on videofluorography and devise diagnostic methods that utilize the advantages of both tools. Furthermore, studies comparing healthy and clinical populations are needed to identify measures most clinically significant in order to develop diagnostic paradigms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DSR:

Deglutitive sphincter resistance

EPT:

Esophageal pressure topography

HRM:

High-resolution manometry

HRPEPT:

High-resolution pharyngeal–esophageal pressure topography

MBS:

Modified barium swallow

mIBP:

Median intrabolus pressure

RI:

Relaxation interval

UES:

Upper esophageal sphincter

VFG:

Videofluorography

References

  1. McConnel FM, Mendelsohn MS, Logemann JA. Examination of swallowing after total laryngectomy using manofluorography. Head Neck Surg. 1986;9(1):3–12.

    Article  PubMed  CAS  Google Scholar 

  2. Ali GN, Wallace KL, Laundl TM, Hunt DR, deCarle DJ, Cook IJ. Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia. Dysphagia. 1997;12(3):133–9.

    Article  PubMed  CAS  Google Scholar 

  3. McConnel FM, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Laryngoscope. 1988;98(7):705–11.

    Article  PubMed  CAS  Google Scholar 

  4. McConnel FM, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after supraglottic laryngectomy. Head Neck Surg. 1987;9(3):142–50.

    Article  PubMed  CAS  Google Scholar 

  5. Ozgursoy OB, Salassa JR. Manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy for cricopharyngeal bar. Otolaryngol Head Neck Surg. 2010;142(5):735–40.

    Article  PubMed  Google Scholar 

  6. Ozgursoy OB, Salassa JR, Reimer R, Wharen RE, Deen HG. Anterior cervical osteophyte dysphagia: manofluorographic and functional outcomes after surgery. Head Neck. 2010;32(5):588–93.

    PubMed  Google Scholar 

  7. Sun J, Xu B, Yuan YZ, Xu JY. Study on the function of pharynx upper esophageal sphincter in globus hystericus. World J Gastroenterol. 2002;8(5):952–5.

    PubMed  Google Scholar 

  8. Kahrilas PJ. Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? Am J Gastroenterol. 2010;105(5):981–7.

    Article  PubMed  Google Scholar 

  9. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21(8):796–806.

    Article  PubMed  CAS  Google Scholar 

  10. Pandolfino JE, Kahrilas PJ. New technologies in the gastrointestinal clinic and research: impedance and high-resolution manometry. World J Gastroenterol. 2009;15(2):131–8.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  CAS  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Mielens JD, Hoffman MR, Ciucci MR, Jiang JJ, McCulloch TM. Automated analysis of pharyngeal pressure data obtained with high-resolution manometry. Dysphagia. 2011;26(1):3–12.

    Article  PubMed  Google Scholar 

  14. Omari TI, Dejaeger E, van Beckevoort D, et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140(5):1454–63.

    Article  PubMed  Google Scholar 

  15. Omari TI, Dejaeger E, Van Beckevoort D, et al. A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol. 2011;106(10):1796–802.

    Article  PubMed  Google Scholar 

  16. Pal A, Williams RB, Cook IJ, Brasseur JG. Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow. Am J Physiol Gastrointest Liver Physiol. 2003;285(5):G1037–48.

    PubMed  CAS  Google Scholar 

  17. Williams RBH, Wallace KL, Ali GN, Cook IJ. Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Am J Physiol Gastrointest Liver Physiol. 2002;283(1):G16–26.

    PubMed  CAS  Google Scholar 

  18. Kahrilas PJ, Clouse RE, Hogan WJ. American gastroenterological association technical review on the clinical use of esophageal manometry. Gastroenterology. 1994;107(6):1865–84.

    PubMed  CAS  Google Scholar 

  19. Orlowski J, Dodds WJ, Linehan JH, Dent J, Hogan WJ, Arndorfer RC. Requirements for accurate manometric recording of pharyngeal and esophageal peristaltic pressure waves. Invest Radiol. 1982;17(6):567–72.

    Article  PubMed  CAS  Google Scholar 

  20. Peghini PL, Pursnani KG, Gideon MR, Castell JA, Nierman J, Castell DO. Proximal and distal esophageal contractions have similar manometric features. Am J Physiol. 1998;274(2 Pt 1):G325–30.

    PubMed  CAS  Google Scholar 

  21. Castell JA, Castell DO. Modern solid state computerized manometry of the pharyngoesophageal segment. Dysphagia. 1993;8(3):270–5.

    Article  PubMed  CAS  Google Scholar 

  22. Holloway RH, Esophageal manometry [review]. GI Motility online. 2006. Available at http://www.nature.com/gimo/contents/pt1/full/gimo30.html (Accessed September 2008).

  23. Ekberg O, Aksglaede K. Radiology of the pharynx and the esophagus. New York: Springer; 2004.

    Book  Google Scholar 

  24. Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95(1):52–62.

    PubMed  CAS  Google Scholar 

  25. Sears VW Jr, Castell JA, Castell DO. Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing. Gastroenterology. 1991;101(6):1559–63.

    PubMed  Google Scholar 

  26. Grübel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008;6(5):525–30.

    Article  PubMed  Google Scholar 

  27. Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95(10):2720–30.

    Article  PubMed  CAS  Google Scholar 

  28. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135(3):756–69.

    Article  PubMed  Google Scholar 

  29. Bammer T, Salassa JR, Klingler PJ. Comparison of methods for determining cricopharyngeal intrabolus pressure in normal patients as possible indicator for cricopharyngeal myotomy. Otolaryngol Head Neck Surg. 2002;127(4):299–308.

    Article  PubMed  Google Scholar 

  30. McConnel FM, Cerenko D, Jackson RT, Guffin TN Jr. Timing of major events of pharyngeal swallowing. Arch Otolaryngol Head Neck Surg. 1988;114(12):1413–8.

    Article  PubMed  CAS  Google Scholar 

  31. Mendelsohn MS, McConnel FM. Function in the pharyngoesophageal segment. Laryngoscope. 1987;97(4):483–9.

    Article  PubMed  CAS  Google Scholar 

  32. Ku DN, Ma PP, McConnel FM, Cerenko D. A kinematic study of the oropharyngeal swallowing of a liquid. Ann Biomed Eng. 1990;18(6):655–69.

    Article  PubMed  CAS  Google Scholar 

  33. Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers. Dysphagia. 1995;10(1):36–41.

    Article  PubMed  CAS  Google Scholar 

  34. Higo R, Nakahira M, Sugasawa M, Nakatsuka T. Manometric assessment of pharyngeal swallowing pressure after mandibular reconstruction. Eur Arch Otorhinolaryngol. 2011;268(6):941–4.

    Article  PubMed  Google Scholar 

  35. Pauloski BR, Rademaker AW, Lazarus C, Boeckxstaens G, Kahrilas PJ, Logemann JA. Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities. Dysphagia. 2009;24(2):196–203.

    Article  PubMed  Google Scholar 

  36. Cook IJ, Dodds WJ, Dantas RO, et al. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257(5 Pt 1):G748–59.

    PubMed  CAS  Google Scholar 

  37. Cook IJ, Gabb M, Panagopoulos V, et al. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103(4):1229–35.

    PubMed  CAS  Google Scholar 

  38. Brasseur JG, Dodds WJ. Interpretation of intraluminal manometric measurements in terms of swallowing mechanics. Dysphagia. 1991;6(2):100–19.

    Article  PubMed  CAS  Google Scholar 

  39. McCulloch TM, 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.

    PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grant R01 DK56033 (PJK) from the Public Health Service.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Noga Nativ-Zeltzer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nativ-Zeltzer, N., Kahrilas, P.J. & Logemann, J.A. Manofluorography in the Evaluation of Oropharyngeal Dysphagia. Dysphagia 27, 151–161 (2012). https://doi.org/10.1007/s00455-012-9405-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-012-9405-1

Keywords

Navigation