High-Resolution Pharyngeal Manometry: Recent Developments and Future Directions

Purpose of Review: This review article will discuss recent developments in high-resolution pharyngeal manometry, including diagnostic applications, and proposed standard metrics and protocol, as well as its use as a therapeutic biofeedback tool. Recent Findings: An International High-Resolution Pharyngeal Manometry (HRPM) Working Group has proposed use of three classes of HRPM metric standardization of HRPM data collection: pharyngeal lumen occlusive pressures (including pressures at the velopharynx, mesopharynx, and hypopharynx), upper esophageal sphincter (UES) function parameters (UES relaxation time and integrated relaxation pressure), and hypopharyngeal intrabolus pressure. The pharyngeal contractile integral (PhCI), in particular, has been shown to have promise as an indicator of the presence of swallowing impairment. Complex biomechanical relationships between pharyngeal drive and UES contractility have been identified, necessitating that clinicians take the entire system into account when assessing pharyngeal swallowing deficits. HRPM biofeedback therapy is an emerging form of dysphagia therapy which provides visual feedback of swallowing performance to patients in real time. Summary: HRPM is a non-radiologic clinical tool that provides objective measures of pharyngeal swallowing pressures and timing. Development of normative values remains an ongoing effort, with only a few studies available that provide normal values for the standard metrics recently proposed by the HRPM International Working Group. HRPM biofeedback dysphagia therapy is safe and well-tolerated, and has anecdotal evidence supporting its use.