Characterising pharyngeal swallowing physiology: Towards clinical application of high-resolution manometry with impedance in children

Author: Lara Ferris

Ferris, Lara, 2022 Characterising pharyngeal swallowing physiology: Towards clinical application of high-resolution manometry with impedance in children, Flinders University, College of Medicine and Public Health

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Given the increasing prevalence of oropharyngeal dysphagia in children, it is crucial to investigate the value of novel, quantitative measures in order to advance clinical dysphagia assessment and management. This thesis demonstrates that catheter-based pharyngeal high-resolution manometry with impedance (P-HRM-I) detects contractility, distension and bolus flow timing through the pharynx and upper oesophageal sphincter (UOS) to characterise distinct biomechanical features of swallowing physiology. These quantitative measurements were the investigative focus of this research program. Enhanced characterisation of healthy oropharyngeal swallowing modulation is shown in response to a wide range of bolus conditions, and normative P-HRM-I references have been generated to guide interpretation of OPD pathophysiology. This research demonstrates insights related to technical aspects of manometry, including a clear influence of catheter diameter on P-HRM-I parameters, emphasising the importance of pressure data interpretation in the context of catheter specifications. Another important consideration proved to be the impact of piecemeal deglutition, whereby use of impedance data can enhance selection of swallows for analysis. Exploration of P-HRM-I in children with OPD demonstrated that UOS dysfunction is particularly relevant to symptoms, highlighting the importance of considering and quantifying UOS biomechanics when evaluating OPD. The P-HRM-I parameters may be especially beneficial as future outcome measures of therapeutic interventions, however paediatric P-HRM-I studies present unique challenges regarding test tolerance and protocol compliance. Therefore, it was necessary to explore strategies to optimise the procedure in children and establish the viability of repeat investigations. This research describes a range of factors which influenced data quality and outlines the lessons learned while optimising application of these methods in children. To continue to reveal the most useful clinical contexts for future P-HRM-I application, ongoing exploration of paediatric swallowing pathophysiology is required in larger cohorts, ideally in comparison with other quantitative instrumental methods.

Keywords: paediatric feeding disorder, paediatric oropharyngeal dysphagia, high resolution manometry, impedance

Subject: Speech Pathology thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Medicine and Public Health
Supervisor: Taher Omari