A Case of Effective Swallowing Exercise Based on Evaluation by High-resolution Manometry

Abstract

　Introduction:　We report a case in which high-resolution manometry (HRM) was used to comprehend the pathophysiology of dysphagia and to objectively evaluate the improvement process, which enabled us to select more effective swallowing exercises.

　Case:　A male in his forties developed a left medullary infarction after coil embolization for a dissecting aneurysm of the left vertebral artery. After 2 days, we performed a videoendoscopic examination and found that he could not perform the swallowing reflex. After 11 days, we performed a videofluoroscopic examination (VF) and HRM and found decreased pharyngeal pressure and reduced upper esophageal sphincter (UES) relaxation time. After 23 days, VF and HRM were performed again, and these showed that his pharyngeal pressure and UES relaxation time had slightly improved. On the same day, the effects of tongue-held swallow, effortful swallow, and the Mendelsohn maneuver were evaluated using HRM. The pharyngeal contractile integrals were higher for tongue-hold swallow, effortful swallow, and the Mendelssohn maneuver than for normal swallow. The UES relaxation time was longer with the Mendelssohn maneuver than with normal swallow. After we explained these findings to him, he practiced these swallowing exercises. After 39 days, his pharyngeal contractile integrals improved further.

　Discussion:　In this case, we were able to comprehend the detailed pathological condition of pharyngeal pressure and UES using HRM. Furthermore, we were able to confirm more effective swallowing exercises using HRM. It is suggested that HRM can contribute to the selection of appropriate exercises for dysphagia rehabilitation.