High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics-Recommendations of a High-Resolution Pharyngeal Manometry International Working Group
Dysphagia
Omari, T. I., Ciucci, M., et al. (2020).
Dysphagia, 35(2), 281-295.
This guideline from an independent High-Resolution Pharyngeal Manometry (HRPM) International Working Group provides consensus-based recommendations for HRPM protocols and metrics.
Medtronic (Ireland); Medical University of South Carolina Department of Otolaryngology – Head and Neck Surgery
According to consensus-based expert advice, high-resolution pharyngeal manometry (HRPM) protocol should include<ol> <li>using a solid-state high-resolution manometry system including a catheter configured with 10 pressure sensors or more;</li> <li>spacing sensors 1 cm apart;</li> <li>spacing any adjacent impedance electrodes 2 cm apart;</li> <li>placing catheters using lubricant gel on the catheter;</li> <li>applying topical anesthesia to the nasal passage;</li> <li>using liquid sips via straw during catheter placement;</li> <li>waiting 5 minutes after placement for catheter accommodation;</li> <li>delivering test boluses using a syringe;</li> <li>modifying test bolus consistency and volumes; and</li> <li>repeating the test at least 3 times or more on a case by case basis.</li></ol>Clinicians should be educated and trained on placing catheters and conducting a HRPM protocol.
According to consensus-based expert advice, key metrics for high-resolution pharyngeal manometry (HRPM) include using<ul> <li>contractile integrals rather than mean peak pressure/maximum pressure;</li> <li>pharyngeal contractile integral (PhCI) as a global measure separate from sub-component contractile integrals (e.g., velopharyngeal contractile integral, mesopharyngeal contractile integral, hypopharyngeal contractile integral);</li> <li>upper esophageal sphincter (UES) integrated relaxation pressure (IRP) as a UES relaxation metric;</li> <li>pressure at Nadir impedance to measure intra-bolus pressure; and</li> <li>impedance measures as part of HRPM.</li></ul>
