D. Lukato1, C. Jones1, S. Rosen1, C. Walczak1, T. McCulloch1 1University Of Wisconsin – Madison,Otolaryngology/Surgery,Madison, WI, USA
Introduction:
Patients with stroke or head and neck cancer (HNCa) often experience long-term effects of dysphagia. Along the swallowing pathway, the proximal esophagus exhibits a unique contractile property compared to the rest of the esophagus. There is currently no clear understanding of how the proximal esophageal contraction is altered in a pathological state. The purpose of this study is to evaluate the effects of stroke and HNCa on swallowing-related proximal esophageal pressure.
Methods:
We analyzed retrospective swallowing pressure data from 62 healthy adults, 9 patients with stroke, and 17 patients with HNCa. Each participant performed three swallows of 1-3 mL of normal saline. High resolution manometry was used to measure four variables: proximal esophageal contraction amplitude; contraction duration; pharyngo-esophageal transition time from the velopharynx; and pharyngo-esophageal transition time from 1 cm above the upper esophageal sphincter (UES). A one-way analysis of variance (ANOVA) was done to compare variables between the three groups. We hypothesize that patients with stroke and HNCa have longer pharyngo-esophageal transition time, shorter contraction duration, and lower proximal esophageal contraction amplitude than in healthy people.
Results:
Patients with stroke experienced significantly longer pharyngo-esophageal transition time from the velopharynx than healthy participants and HNCa patients (p < 0.01). Patients with stroke exhibited longer pharyngo-esophageal transition time from 1cm above the UES than both controls and HNCa patients (p < 0.01). HNCa patients had significantly longer pharyngo-esophageal transition time from 1 cm above the UES than healthy participants (p <0.05). The control group experienced significantly longer contraction duration than both stroke and HNCa groups (p < 0.05 and p < 0.01, respectively). No significant differences in contraction amplitude were observed (p > 0.05).
Conclusion:
Patients with stroke and HNCa experience delayed onset of proximal esophageal contraction and shorter contraction duration. These findings may be helpful to clinicians for understanding the effects of stroke and HNCa on swallowing. Future directions to address our limitations include evaluation of the proximal esophageal contraction with different bolus volumes, consistency, and swallowing techniques.