Abstract
OBJECTIVE: The upper esophageal sphincter (UES) serves multiple functions in the management of the upper aerodigestive tract. Prior investigations have defined the roles of UES resting and nadir pressures in normal swallowing. The distinctly high-amplitude UES peak pressures, a patterned feature of pressure propagation in the transition from the pharynx to the esophagus on high-resolution manometry (HRM), have not been characterized beyond normative data reports. This study investigated the relationship between peak UES and pharyngeal pressures at the velopharyngeal and tongue base regions in both patients with dysphagia and healthy controls. METHODS: Sixty-three adult patients with dysphagia underwent pharyngeal HRM to obtain peak measures of velopharyngeal, tongue base region, and UES pressures. Age- and sex-matched healthy controls were analyzed for comparison. RESULTS: UES peak pressures in patients with dysphagia showed no significant correlation with velopharyngeal or tongue base region pressures (p > 0.05). In contrast, UES peak pressures were positively correlated with velopharyngeal (r = 0.525, p < 0.001) and tongue base (r = 0.415, p = 0.001) region peak pressures in healthy subjects. Velopharyngeal region pressures showed a significant correlation with tongue base region pressures in both patients with dysphagia (r = 0.377, p = 0.002) and healthy subjects (r = 0.406, p = 0.001). CONCLUSIONS: Pharyngeal and UES peak pressures are correlated in healthy subjects; loss of this relationship in patients with dysphagia indicates that UES peak pressures may be influenced by factors independent of pharyngeal contractile responses and bolus-related sensory feedback. LEVEL OF EVIDENCE: 4.