[Intraluminal pressure profiles in the pharyngeal phase in both normal and abnormal subjects]

Intraluminal pressure change in the pharyngeal phase of swallowing was measured by the station pull-through method, in which a pressure transducer probe was being withdrawn at each 1 cm step from a segment 25 to 8 cm from the nostril. The probe had an outside diameter of 5.0 mm in size and was loaded with two miniature pressure transducers 3 cm apart from each other. Electromyogram of the suprahyoid muscles was simultaneously recorded with a surface electrode as an index of the second phase of deglutition. The three formats to analyze pressure wave forms in swallowing were designed as followings; a swallowing pressure curve showing peak values at each level, a conduction curve of swallowing pressure indicating the times when the peak of the pressure appeared at each level, and a calculation of the onset of relaxation and its duration at the portion of high pressure zone of the upper esophagus (UHPZ). Analyses of the data in 30 normal subjects revealed the following results. 1) All showed swallowing pressure curves with 3 peaks at the levels of the velopharynx, hypopharynx and cervical esophagus. 2) Normal ranges of the pressure at each level of the peak were 48.2-139 mmHg, 46.4-132 mmHg and 9.0-111 mmHg, respectively. 3) Conduction curves of swallowing pressure showed an "S" like figure in all and the gradient was steep at the level of the oropharynx and hypopharynx. 4) The duration of relaxation at the paroxysmal end within the UHPZ was shorter than that at the distal in all. The normal range of the duration of relaxation at the paroxysmal end was 365-833 msec. Profiles of swallowing in 130 patients with dysphagia showed the following results. 5) Pressure curves in swallowing were classified into 4 pathological patterns of curve depending on the site of a lesion. 6) Two of all showed an abnormal pattern of the conduction curve, which was supposed to be originated by a disorder in the preprogrammed process in swallowing. 7) Two of all also showed abnormally earlier onset of relaxation within the UHPZ. 8) Of all, 3 showed short duration of relaxation within the UHPZ abnormally.