Hiroshi Umeki

Investigation of Pharyngeal Swallowing Function Using High-Resolution Manometry

Objectives/Hypothesis: This study aimed to demonstrate the feasibility of a novel high‐resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.

Effects of a tongue-holding maneuver during swallowing evaluated by high-resolution manometry.

Objective: This study aimed to investigate the effects of a tongue-holding maneuver (THM) during swallowing using a novel high-resolution manometry (HRM) system. Study Design: Case series with planned data collection. Materials and Methods: Thirty-three asymptomatic Japanese adults were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1-cm apart was positioned to record pressures from the velopharynx to the upper esophagus at rest and during swallowing. The maximum values of the dry swallowing pressures at the velopharynx, mesohypopharynx, upper esophageal sphincter (UES), and distance from the nostril to each point of maximum values with and without the THM were measured. Results: The distance from the nostril to the UES was statistically shorter when swallowing with the THM than without the THM (paired t test, P = 0.009). The maximum pressure at UES was greater when swallowing with the THM than without the THM, although there was no statistically significant difference (paired t test, P = 0.051). There was no difference in the pressures and the distance between swallowing with or without the THM at any other site. Conclusions: These findings suggest that the THM may not have a potential to facilitate compensatory swallowing power when swallowing.

Influence of head rotation on upper esophageal sphincter pressure evaluated by high-resolution manometry system

Objectives: This study aimed to quantify the effects of head rotation on upper esophageal sphincter (UES) pressure in healthy subjects using a novel high-resolution manometry (HRM) system. Study Design: Prospective study. Setting: Nagasaki University Hospital. Subjects and Methods: Eighteen asymptomatic Japanese male adult volunteers were studied. A solid-state HRM was positioned to record resting UES pressure. After endoscopically confirming on which side of the pyriform sinus the manometric sensor was positioned within the hypopharynx, we measured the maximum and mean values of the resting UES pressure and the length of the zone of the UES along the esophagus with the patients in the following positions: 1) neutral and straightforward head position (NSF), 2) turning the head in the direction of the side in which the sensor was positioned (HSS), and 3) turning the head in the opposite direction of the side with sensor (HOS). Results: The maximum and mean values of the resting UES pressure were statistically higher in HSS than in NSF (P = 0.0001 and P < 0.0001, respectively), and were statistically lower in HOS than in NSF (P < 0.0001 and P < 0.0001, respectively). The length of the zone of the UES was statistically shorter in HOS than in NSF (P < 0.0001), but there was no significant difference in resting UES pressure along the esophagus between HSS and NSF (P = 0.3024). Conclusion: The present study provided us with physiological information regarding normal UES pressure in relation to head rotation. This data will be of aid to future clinical and investigative swallowing studies. Additionally, the current study provides evidence of the safety and usefulness of the head rotation maneuver for dysphagic patients.

Influence of Effortful Swallow on Pharyngeal Pressure Evaluation Using a High-Resolution Manometry

Objective. To evaluate the effect of effortful swallow on pharyngeal pressure while swallowing saliva and water using a novel high-resolution manometry (HRM) system. Study Design. Case series with planned data collection. Setting. Nagasaki University Hospital. Subjects and Methods. Eighteen asymptomatic Japanese adult volunteers were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned from the velopharynx to the upper esophagus to record pressures while swallowing. The maximum values of the pressure while swallowing saliva (dry swallowing) and 5 mL of water were measured at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) with and without effortful swallows. Results. The maximum values of dry swallowing pressures (mm Hg) at the velopharynx, meso-hypopharynx, and UES were significantly higher with effortful swallow (155.7 ± 59.7, 256.7 ± 78.7, and 276.5 ± 87.5, mean ± standard deviation) than without it (115.3 ± 60.8, 172.9 ± 57.0, and 195.8 ± 61.3). Those of water swallowing pressures were also statistically higher with effortful swallow (169.3 ± 69.1, 236.6 ± 77.2, and 267.3 ± 79.1) than without it (119.2 ± 59.7, 189.5 ± 70.7, and 221.3 ± 72.7). Conclusion. The present results provide quantitative evidence of effortful swallow as well as physiological information. It also is hoped to be an aid to future clinical and investigative studies.

Evaluation of swallowing pressure in a patient with amyotrophic lateral sclerosis before and after cricopharyngeal myotomy using high-resolution manometry system

BACKGROUND This study aimed to evaluate the pharyngeal pressure of a patient with, amyotrophic lateral sclerosis (ALS) before and after cricopharyngeal myotomy by high-resolution manometry (HRM) system. METHODS A 60-year-old man with ALS underwent cricopharyngeal myotomy for his intractable, aspiration. The swallowing pressure along the velopharynx and upper esophagus was measured using, the HRM 1 month before and 3 months after the surgery. RESULTS Before cricopharyngeal myotomy, the maximum values of the resting UES pressure, the dry swallowing, pressures in the velopharyngeal muscle zone and in the UES zone were 89, 95, and 171 mmHg, respectively. After surgery, the maximum values of both the resting pressure and dry swallowing, pressure in the UES zone remarkably decreased to 21 and 75 mmHg, respectively. CONCLUSIONS This is the first report showing the effect of cricopharyngeal myotomy by demonstrating, the difference in the swallowing pressure along the velopharynx and upper esophagus before and after, the surgery in an ALS patient using this HRM system.

The Patulous Eustachian Tube Complicated With Amyotrophic Lateral Sclerosis: A Video Clip Demonstration

We report a 60‐year‐old case diagnosed as the amyotrophic lateral sclerosis with patulous eustachian tube (ET). To our knowledge, this is the first case report of the amyotrophic lateral sclerosis complicating patulous ET in the literature, demonstrating the movement of the tympanic membrane, the pharyngeal orifice of the ET and abnormal movement of the uvula because of paralysis of the soft palate on video.

S119 – Tongue-holding Maneuver Studied by High-resolution Manometry

Objectives This study aimed to investigate the effects of a tongue-holding maneuver (THM) during swallowing, using a novel high-resolution manometry (HRM) system. Methods 27 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the dry swallowing pressures at meso-hypopharynx, the upper esophageal sphincter (UES) and the mean values at meso-hypopharynx with and without THM were measured. Results The maximum values of dry swallowing pressures with and without THM were 195.0±77.2 (mmHg, mean ± standard deviation), and 178.1±53.0 at the meso-hypopharynx, and 213.4±74.0 and 190.0±95.0 at the UES, respectively. The mean values with and without THM at meso-hypopharynx were 47.4±11.9, and 44.0±11.2, respectively. The maximum value at UES (p=0.0347), and the mean value at the meso-hypopharynx (p=0.0124) of dry swallowing pressures with THM were significantly higher than those without THM. Conclusions These findings indicate that the THM has a potential to facilitate compensatory swallowing power at the pharynx and upper esophagus. HRM will provide us with important information about the swallowing physiology, and pathophysiology along the velopharynx, and upper esophagus.