Relationship Between Tongue Base Region Pressures and Vallecular Clearance

Tongue base pressures have been thought to provide primary bolus clearance through the pharynx during swallowing. The relationship between bolus driving pressures and residue remaining in the valleculae after the swallow has not been defined. Thirty-seven dysphagic patients who were evaluated with both videofluoroscopy (VFSS) and high-resolution manometry (HRM) were identified within the University of Wisconsin Voice and Swallowing Outcomes database. Patients were categorized according to binary ratings of presence or absence of vallecular stasis as well as incomplete or complete tongue retraction on VFSS. Tongue base region pressures measured with HRM during saline swallows of 1 and 10 ml volumes were compared to ratings of vallecular stasis or tongue base retraction. No significant difference could be identified among mean peak HRM pressures when compared to presence or absence of vallecular stasis (1 ml saline: p = .1886; 10 ml saline: p = .7354). When categorized according to complete or incomplete tongue retraction, mean peak HRM pressures were significantly greater in the complete tongue retraction group as compared to incomplete tongue retraction (1 ml saline: p = .0223; 10 ml saline: p = .0100). Findings suggest there are multiple factors that lead to reduced vallecular clearance. In the absence of HRM measures, judging complete or incomplete tongue retraction on VFSS may be a more valid gauge of tongue base region pressures than vallecular clearance when planning dysphagia treatment.