Relationship between Swallowing Pressure and Saliva Residue on Endoscopic Evaluation in Pharyngeal Dysphagia

• Published in: The Laryngoscope 2024-08, Vol.134 (8), p.3519-3526
• Main Authors: Chitose, Shun‐ichi, Fukahori, Mioko, Kurita, Takashi, Hamakawa, Sachiyo, Sato, Kiminobu, Kuroiwa, Taikai, Ono, Takeharu, Umeno, Hirohito, Sato, Kiminori
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Deglutition - physiology; Deglutition Disorders - diagnosis; Deglutition Disorders - physiopathology; Dysphagia; Endoscopy; Endoscopy - methods; Esophageal Sphincter, Upper - physiopathology; Female; high‐resolution manometry; Humans; Male; Manometry - methods; Middle Aged; pharynx; Pharynx - physiopathology; piriform sinus; Pressure; Saliva - chemistry; saliva residue; Sinuses; swallowing pressure; vallecula
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.31358

Objective In pharyngeal dysphagia, poor pharyngeal contraction and upper esophageal sphincter (UES) dysfunction result in post‐swallow saliva residue (SR). This study aimed to clarify the relationship between swallowing pressure and SR in the valleculae and piriform sinuses on flexible endoscopic evaluation of swallowing (FEES). Methods Pharyngeal dysphagia patients with Wallenberg syndrome were included. Amounts of post‐swallow SR in the valleculae and piriform sinuses were classified into four grades using SR scores based on FEES. The Hyodo score was also calculated to evaluate swallowing function. High‐resolution manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro‐hypopharyngeal, and UES zones on swallowing were obtained for comparison with SR and Hyodo scores. Results Of the 31 recruited, data from 26 patients who successfully underwent FEES and manometry were analyzed. Vallecular SR scores were strongly negatively correlated with a maximum pressure of the oropharynx (r = −0.52, p = 0.006), distal contractile integrals (DCI) of the oropharynx (r = −0.52, p = 0.007), and DCI of the oro‐hypopharynx (r = −0.55, p = 0.004). Hyodo scores for parameters 1 and 4 (corresponding to salivary pooling and pharyngeal clearance, respectively) were strongly negatively correlated with a maximum hypopharyngeal pressure (r = −0.57, p = 0.002) and strongly positively correlated with peristaltic velocity (r = 0.53, p = 0.007), respectively. SR scores and Hyodo scores related to SR were not correlated with pressure data of the UES. Conclusion Manometric analysis of our SR scoring method using FEES revealed that a higher amount of SR in the valleculae, but not in the piriform sinuses, is associated with weaker pharyngeal pressure in pharyngeal dysphagia, especially at the oropharyngeal level. Level of Evidence 4 Laryngoscope, 134:3519–3526, 2024 Amounts of post‐swallow saliva residue (SR) in the valleculae and piriform sinuses were classified into four grades using SR scores based on flexible endoscopic evaluation of swallowing (FEES). SR scores and Hyodo scores related to SR were compared with high‐resolution manometry pressure data. This study revealed that a higher amount of SR in the valleculae is associated with weaker pharyngeal pressure in pharyngeal dysphagia, especially at the oropharyngeal level.