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High-Resolution Manometry Evaluation of Pressures at the Pharyngo-Upper Esophageal Area in Patients With Oropharyngeal Dysphagia Due to Vagal Paralysis
Bruno R. Pinna², Fernando A. Herbella^*1, Marco G. Patti^3
1Surgery, Federal University of Sao Paulo, Sao Paulo, São Paulo, Brazil; ²Department of Otholaryngology, Federal University of São Paulo, Sao Paulo, Brazil; ³Department of Surgery, University of Chicago, Chicago, IL

Background: The motility of the pharynx, upper esophageal sphincter (UES) and proximal esophagus in patients with oropharyngeal dysphagia is a topic of the digestive physiology still not entirely understood even though their proximal anatomic position facilitates access to diagnostic tests. Most of the tests used as part of the work up in patients with oropharyngeal dysphagia by otolaryngologists and digestive surgeons alike include anatomy tests when the physiology is indirectly inferred. High resolution manometry (HRM) was recently added to the armamentarium for the study of this area due to technological advances in comparison to conventional manometry, such as the circumferential disposition of the sensors, compensation for motion artifacts and the ability to detect rapid pressure changes.
Aims: This study aim to describe preliminary HRM findings in patients with oropharyngeal dysphagia due to vagal paralysis.
Methods: Fourteen patients (mean age 57 years, 57% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the upper esophageal sphincter (UES) and at the topography of the velopharynx and epiglottis were recorded (figure 1).
Results: Manometric parameters are depicted in table 1. UES was hypotonic in half of the patients and the pharynx in the majority of patients. UES relaxation is normal in most cases.
Conclusion: Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed towards improvement in the oropharyngeal motility not at the UES.
Manometric findings

	Patients	Reference values
Upper esophageal sphincter resting pressure hypertonic hypotonic	60 (36-84) 2 (14%) 7 (50%)	58-109
Upper esophageal sphincter residual pressure abnormal	3 (2-5) 3 (21%)	1-7
Velopharynx peak pressure hypertonic hypotonic	17 (5-24) 1 (7%) 12 (86%)	100-164
Epiglottis peak pressure hypertonic hypotonic	7 (3-22) - 13 (93%)	97-139

Values as mean (quartile) in mmHg or n (%)

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