Objective assessment of swallow function in children with suspected aspiration using pharyngeal automated impedance manometry

OBJECTIVES:: The purpose of the present study was to apply a new method, pharyngeal automated impedance manometry (AIM), as an objective assessment tool of swallow function relevant to aspiration, in a cohort of paediatric patients with dysphagia. METHODS:: We studied 20 children (mean age 6 years [5 months to 13.4 years]) referred for videofluoroscopy to assess aspiration risk with simultaneous manometry-impedance. Fluoroscopic evidence of aspiration was scored using a validated aspiration-penetration score. Pressure-flow profiles were analysed using AIM analysis measuring peak pressure, pressure at nadir impedance, time from nadir impedance to peak pressure, and flow interval. These variables were combined into a swallow risk index (SRI). RESULTS:: Six of 20 children presented with deglutitive aspiration during videofluoroscopic assessment of swallowing. Of 58 liquid swallows analysed, in 9 aspiration was observed. Multiple logistic regression identified longer flow interval (P<0.05), higher SRI (P<0.05) and increased pressure in the upper oesophageal sphincter during maximal bolus flow (P<0.05) to be the dominant risk variables predictive of aspiration in children. Each of these nonradiologically derived pressure-flow variables correlated with higher aspiration scores on videofluoroscopy (P<0.01). CONCLUSIONS:: We present novel, preliminary findings in children with deglutitive aspiration, suggesting that pharyngeal AIM can detect alterations in pressure-flow characteristics of swallowing that predispose to aspiration risk.