Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation |
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| Affiliation: | 1. ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy;2. Audiology and Phoniatry Service, Infermi Hospital, Rimini, Italy;3. Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy;4. Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy;5. Gastroenterology Unit, University of Pisa, Pisa, Italy;1. Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan;2. Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA;3. Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan;4. Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan;1. Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan;2. Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan;3. Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan;5. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan;6. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan;1. Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan;2. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;3. Department of Otorhinolaryngology, Toyota Kosei Hospital, Toyota, Japan;4. Department of Otorhinolaryngology, Anjo Kosei Hospital, Anjo, Japan;5. Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Science, Nagoya, Japan;6. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;1. Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan;2. Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan |
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| Abstract: | ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams.MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects.ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied.ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing. |
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