Skip to main content
Top
Published in: Dysphagia 2/2012

01-06-2012 | Review Article

Manofluorography in the Evaluation of Oropharyngeal Dysphagia

Authors: Noga Nativ-Zeltzer, Peter J. Kahrilas, Jerilyn A. Logemann

Published in: Dysphagia | Issue 2/2012

Login to get access

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.
Literature
1.
go back to reference McConnel FM, Mendelsohn MS, Logemann JA. Examination of swallowing after total laryngectomy using manofluorography. Head Neck Surg. 1986;9(1):3–12.PubMedCrossRef McConnel FM, Mendelsohn MS, Logemann JA. Examination of swallowing after total laryngectomy using manofluorography. Head Neck Surg. 1986;9(1):3–12.PubMedCrossRef
2.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
3.
go back to reference McConnel FM, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Laryngoscope. 1988;98(7):705–11.PubMedCrossRef McConnel FM, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Laryngoscope. 1988;98(7):705–11.PubMedCrossRef
4.
go back to reference McConnel FM, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after supraglottic laryngectomy. Head Neck Surg. 1987;9(3):142–50.PubMedCrossRef McConnel FM, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after supraglottic laryngectomy. Head Neck Surg. 1987;9(3):142–50.PubMedCrossRef
5.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
6.
go back to reference 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 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
7.
go back to reference 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 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
8.
go back to reference Kahrilas PJ. Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? Am J Gastroenterol. 2010;105(5):981–7.PubMedCrossRef Kahrilas PJ. Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? Am J Gastroenterol. 2010;105(5):981–7.PubMedCrossRef
9.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
10.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
11.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
12.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
13.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
14.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference 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 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
17.
go back to reference 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 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
18.
go back to reference 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 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
19.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
20.
go back to reference 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 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
21.
go back to reference Castell JA, Castell DO. Modern solid state computerized manometry of the pharyngoesophageal segment. Dysphagia. 1993;8(3):270–5.PubMedCrossRef Castell JA, Castell DO. Modern solid state computerized manometry of the pharyngoesophageal segment. Dysphagia. 1993;8(3):270–5.PubMedCrossRef
23.
go back to reference Ekberg O, Aksglaede K. Radiology of the pharynx and the esophagus. New York: Springer; 2004.CrossRef Ekberg O, Aksglaede K. Radiology of the pharynx and the esophagus. New York: Springer; 2004.CrossRef
24.
go back to reference Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95(1):52–62.PubMed Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95(1):52–62.PubMed
25.
go back to reference Sears VW Jr, Castell JA, Castell DO. Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing. Gastroenterology. 1991;101(6):1559–63.PubMed Sears VW Jr, Castell JA, Castell DO. Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing. Gastroenterology. 1991;101(6):1559–63.PubMed
26.
go back to reference Grübel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008;6(5):525–30.PubMedCrossRef Grübel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008;6(5):525–30.PubMedCrossRef
27.
go back to reference Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95(10):2720–30.PubMedCrossRef Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95(10):2720–30.PubMedCrossRef
28.
go back to reference Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135(3):756–69.PubMedCrossRef Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135(3):756–69.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
31.
go back to reference Mendelsohn MS, McConnel FM. Function in the pharyngoesophageal segment. Laryngoscope. 1987;97(4):483–9.PubMedCrossRef Mendelsohn MS, McConnel FM. Function in the pharyngoesophageal segment. Laryngoscope. 1987;97(4):483–9.PubMedCrossRef
32.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
33.
go back to reference Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers. Dysphagia. 1995;10(1):36–41.PubMedCrossRef Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers. Dysphagia. 1995;10(1):36–41.PubMedCrossRef
34.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
35.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
36.
go back to reference 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 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
37.
go back to reference 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 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
38.
go back to reference Brasseur JG, Dodds WJ. Interpretation of intraluminal manometric measurements in terms of swallowing mechanics. Dysphagia. 1991;6(2):100–19.PubMedCrossRef Brasseur JG, Dodds WJ. Interpretation of intraluminal manometric measurements in terms of swallowing mechanics. Dysphagia. 1991;6(2):100–19.PubMedCrossRef
39.
go back to reference 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 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
Metadata
Title
Manofluorography in the Evaluation of Oropharyngeal Dysphagia
Authors
Noga Nativ-Zeltzer
Peter J. Kahrilas
Jerilyn A. Logemann
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Dysphagia / Issue 2/2012
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-012-9405-1

Other articles of this Issue 2/2012

Dysphagia 2/2012 Go to the issue