Objectives: Diminished pharyngeal constriction is a common biomechanical deficit associated with dysphagia and holds strong predictive value for aspiration. Pharyngeal squeeze manoeuvre (PSM) was previously validated for evaluating pharyngeal constriction on endoscopy. However, PSM is not routinely used in laryngology clinics or flexible endoscopic evaluation of swallowing (FEES) protocols worldwide. This study explored PSM in the acute care setting and its relationship with swallowing safety and efficiency, other swallowing biomechanical functions, and clinical outcomes.
Methods: This prospective observational study consented 222 consecutive inpatients of mixed aetiology who were receiving FEES as part of their standard care. Established FEES protocols were performed including assessment of secretion accumulation, urge-to-clear ratings, laryngeal motor, and sensory functional tests, PSM, as well as aspiration, and residue during oral trials. Swallow frequency and cough peak flow were also collected as well as clinical outcomes at discharge.
Results: PSM was impaired in 46% of the patients. Accumulated secretions, penetration-aspiration, and post-swallow residue were frequent and correlated with abnormal PSM (p < 0.05). PSM was reliable and agreed with pharyngeal constriction ratio on videofluoroscopy in all 15 patients who had both assessments within 72 h. Abnormal PSM correlated with vocal cord immobility, reduced peak cough flow, and reduced swallow frequency (p < 0.05). Abnormal PSM predicted restricted diet on hospital discharge with an odds ratio of 10.38.
Conclusions: PSM is a quick and simple addition to an endoscopic evaluation and has the potential to predict likelihood of impaired swallow safety and efficiency as well as clinical outcomes.
Level of evidence: 3 Laryngoscope, 133:3429-3435, 2023.
Keywords: deglutition; dysphagia; endoscopy; flexible endoscopic evaluation of swallowing; pharyngeal constriction; pharyngeal squeeze.
© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.