The impact of upper esophageal sphincter (UES) dysfunction management on velopharyngeal, hypopharyngeal, and UES pressures

Upper esophageal sphincter (UES) dysfunction is a disorder where there is a restriction at the junction between the pharynx and esophagus that impacts a person’s ability to swallow. UES dysfunction can be diagnosed with a modified barium swallow study or high-resolution manometry (HRM). HRM measures pressure in the pharynx during swallowing. Treatment for UES dysfunction includes myotomy, dilation, and Botox injections, but it is unknown how swallowing pressure change in HRM following treatment. We hypothesized that UES dysfunction would impact other pharyngeal pressures including the velopharynx, hypopharynx, and pressures of the UES. We analyzed data, collected from a clinical database at the University of Wisconsin Madison, from 12 individuals who were diagnosed with UES dysfunction that underwent UES dysfunction treatment, with HRM studies before and after treatment. We found a statistically significant decrease in hypopharyngeal pressure integral (p = 0.005), UES resting pressure (p = 0.0065), and UES residual pressure (p = 0.0065). We also found that there was not a statistically significant decrease in velopharyngeal pressure integral, UES minimum pressure, and UES duration of minimum pressure. We concluded there are some pressure zones in the pharynx and UES that are impacted by the increased pressure at the UES due to UES dysfunction. Therefore, UES dysfunction does not only impact the UES. As a result, when clinicians evaluate patients with UES dysfunction, they will need to examine more than the UES.Communication Sciences and Disorder