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.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Exploratory/Developmental Grants Phase II (R33)
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Special Emphasis Panel (ZRG1-ETTN-H (51))
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Shekim, Lana O
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University of Wisconsin Madison
Schools of Medicine
United States
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Jones, Corinne A; Rogus-Pulia, Nicole M; Forgues, Angela L et al. (2018) SLP-Perceived Technical and Patient-Centered Factors Associated with Pharyngeal High-Resolution Manometry. Dysphagia :
Jones, Corinne A; Duffy, Mary K; Hoffman, Sarah A et al. (2018) Vocalization development in common marmosets for neurodegenerative translational modeling. Neurol Res 40:303-311
Jones, Corinne A; Forgues, Angela L; Rogus-Pulia, Nicole M et al. (2018) Correlates of Early Pharyngeal High-Resolution Manometry Adoption in Expert Speech-Language Pathologists. Dysphagia :
Jones, C A; Hoffman, M R; Lin, L et al. (2018) Identification of swallowing disorders in early and mid-stage Parkinson's disease using pattern recognition of pharyngeal high-resolution manometry data. Neurogastroenterol Motil 30:e13236
Rosen, Sarah P; Abdelhalim, Suzan M; Jones, Corinne A et al. (2018) Effect of Body Position on Pharyngeal Swallowing Pressures Using High-Resolution Manometry. Dysphagia 33:389-398
Cock, Charles; Jones, Corinne A; Hammer, Michael J et al. (2017) Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing. Dysphagia 32:216-224
Rosen, Sarah P; Jones, Corinne A; McCulloch, Timothy M (2017) Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry. Laryngoscope 127:1989-1995
Hutcheson, Katherine A; Hammer, Michael J; Rosen, Sarah P et al. (2017) Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography. Laryngoscope 127:797-804
Omari, Taher I; Jones, Corinne A; Hammer, Michael J et al. (2016) Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening. Am J Physiol Gastrointest Liver Physiol 310:G359-66
Jones, Corinne A; Ciucci, Michelle R; Hammer, Michael J et al. (2016) A multisensor approach to improve manometric analysis of the upper esophageal sphincter. Laryngoscope 126:657-64

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