A review of pharyngeal manometry normative data (Walters et al., 2023)

Purpose: The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values.Method: A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure.Results: Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters.Conclusions: Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics.Supplemental Material S1. Findings for all mean consensus metrics, as well as variations in catheter diameter, manufacturer, patient positioning, sampling frequency, and bolus types and volumes.Walters, R. K., Gudipudi R., Gordis, T., Davidson, K., Nguyen, S. A., & O’Rourke, A. K. (2023). A systematic review of pharyngeal high-resolution manometry normative data. American Journal of Speech-Language Pathology, 33(2), 1059–1068. https://doi.org/10.1044/2023_AJSLP-23-00221

目的：高分辨率咽压计（HRPM）在评估咽部吞咽困难中的应用日益增多；然而，其使用的标准化进程却相对滞后。在缺乏标准化及规范值的背景下，临床医生将这一新兴技术应用于实际工作中面临困难。本研究的目的是对已发表的HRPM常见指标的规范值进行映射和比较，以帮助确立共识性参考值。方法：对包括HRPM指标的前瞻性和回顾性研究进行了系统综述，这些指标由国际工作组达成共识。当数据可用时，提取以下变量的数据：咽部收缩积分（PhCI）、软腭、咽峡、喉咽以及上食管括约肌（UES）的整合松弛压力（IRP）、松弛时间（RT）、最大导纳和喉咽部气囊内压力。结果：纳入了三十项研究。不同研究间在操作技术和设备使用方面存在显著差异。与老年人相比，年轻个体的PhCI和UES IRP较低。站立位个体的UES RT高于仰卧位，以及使用较大团块大小或较小导管尺寸的个体。结论：由于现有文献中广泛多样的方案、导管配置、制造商和软件，难以通过汇总数据来制定HRPM规范值。进行标准化HRPM方案的前瞻性研究，针对特定导管配置和制造商，并拥有更大正常个体队列，对于确立HRPM指标的适当参考值是必要的。补充材料S1：所有平均共识指标的发现，以及导管直径、制造商、患者体位、采样频率、团块类型和体积的变异性。Walters, R. K., Gudipudi R., Gordis, T., Davidson, K., Nguyen, S. A., & O’Rourke, A. K. (2023). 咽部高分辨率咽压计规范数据系统综述。美国言语-语言病理学杂志，33(2)，1059–1068. https://doi.org/10.1044/2023_AJSLP-23-00221