Swallowing is a critical life function and its failure leads to life threatening complications. Swallow-related behaviors involve the modulation of complex, adaptive muscular contractions to produce pressures and valving events throughout the oral cavity, laryngo-pharynx and esophagus. However, our understanding of the mechanisms that generate and modulate these pressures remains incomplete. Efficient swallow is the result of a pressure gradient that maximizes the probability of complete bolus transfer into the esophagus. High Resolution Manometry (HRM) can directly measure these pressure patterns along the length of the pharynx and provides a quantifiable, comprehensive data set directly characterizing each swallow event. The use of HRM is in its infancy and due to its unique capabilities, has the potential to become an exceptionally valuable tool in the diagnosis and management of pharyngeal swallowing disorders. When coupled with videofluoroscopic (VF) evaluations, HRM/VF could provide the detailed, multi-dimensional assessment that will define the structures and movements which generate pressure, redefine the models of normal and dysfunctional swallow, increase accuracy of diagnosis, and directly measure therapeutic effect. However, the lack of a comprehensive analysis of the pressure patterns currently precludes the use of HRM in evidence- based practice. The overarching goal of this research proposal is to develop new clinical capabilities for the diagnosis of impaired pharyngeal swallowing by optimizing HRM analysis and combining results with those obtained by VF. This new technology will then be used to determine the extent to which these combined technologies can optimize diagnosis of dysphagia in populations with variable swallowing impairment. In the final phase of this work, we will test clinical acceptance of this new tool. This work is highly significant because HRM combined with VF when analyzed appropriate and optimized will augment interventions in the clinical care of patients with dysphagia.

Public Health Relevance

Swallowing is a critical life function that must be performed safely to ensure adequate nutrition and avoid airway compromise;failure can lead to life threatening complications. Complex pressures are generated during the swallow and directly measuring these pressures along with x-ray video images of the swallow can provide a great deal of information for diagnosing and treating swallowing problems. The proposed research will develop and test a new method of analyzing, displaying and classifying multiple pressures and images generated during the swallow to allow physicians and speech language pathologists to improve the accuracy of diagnosis and management of swallowing disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Exploratory/Developmental Grants Phase II (R33)
Project #
5R33DC011130-04
Application #
8625192
Study Section
Special Emphasis Panel (ZRG1-ETTN-H (51))
Program Officer
Shekim, Lana O
Project Start
2011-03-11
Project End
2016-02-28
Budget Start
2014-03-01
Budget End
2015-02-28
Support Year
4
Fiscal Year
2014
Total Cost
$548,606
Indirect Cost
$174,017
Name
University of Wisconsin Madison
Department
Surgery
Type
Schools of Medicine
DUNS #
161202122
City
Madison
State
WI
Country
United States
Zip Code
53715
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Knigge, Molly A; Thibeault, Susan; McCulloch, Timothy M (2014) Implementation of high-resolution manometry in the clinical practice of speech language pathology. Dysphagia 29:2-16
Jones, Corinne A; Knigge, Molly A; McCulloch, Timothy M (2014) Speech pathologist practice patterns for evaluation and management of suspected cricopharyngeal dysfunction. Dysphagia 29:332-9
Jones, Corinne A; Hoffman, Matthew R; Geng, Zhixian et al. (2014) Reliability of an automated high-resolution manometry analysis program across expert users, novice users, and speech-language pathologists. J Speech Lang Hear Res 57:831-6
Jones, Corinne A; Hammer, Michael J; Hoffman, Matthew R et al. (2014) Quantifying contributions of the cricopharyngeus to upper esophageal sphincter pressure changes by means of intramuscular electromyography and high-resolution manometry. Ann Otol Rhinol Laryngol 123:174-82
Juan, Junerose; Hind, Jacqueline; Jones, Corinne et al. (2013) Case study: application of isometric progressive resistance oropharyngeal therapy using the Madison Oral Strengthening Therapeutic device. Top Stroke Rehabil 20:450-70