Pharyngeal Squeeze Maneuver During Endoscopy-What Does it Tell Us?

Area of Science:

• Otolaryngology
• Swallowing Disorders
• Biomechanical Analysis

Background:

• Diminished pharyngeal constriction is a key indicator of dysphagia and aspiration risk.
• The pharyngeal squeeze manoeuvre (PSM) is validated for assessing pharyngeal constriction via endoscopy.
• PSM is underutilized in routine clinical practice and flexible endoscopic evaluation of swallowing (FEES) protocols.

Purpose of the Study:

• To explore the utility of PSM in an acute care setting.
• To investigate the relationship between PSM and swallowing safety, efficiency, and other biomechanical functions.
• To determine the correlation between PSM and clinical outcomes in patients undergoing FEES.

Main Methods:

• A prospective observational study involving 222 inpatients undergoing FEES.
• Standard FEES protocols were employed, including assessment of secretions, laryngeal function, PSM, aspiration, and residue.
• Swallow frequency, cough peak flow, and clinical outcomes at discharge were also recorded.

Main Results:

• PSM was impaired in 46% of patients, correlating with increased secretions, aspiration, and residue.
• Abnormal PSM was linked to vocal cord immobility, reduced peak cough flow, and decreased swallow frequency.
• PSM demonstrated reliability, agreeing with videofluoroscopy findings, and predicted a 10.38-fold increased likelihood of diet restriction at discharge.

Conclusions:

• PSM is a rapid and straightforward addition to endoscopic swallowing evaluations.
• PSM has significant potential for predicting impaired swallow safety and efficiency.
• Abnormal PSM can serve as a predictor of clinical outcomes in dysphagia patients.