title: Objective assessment of swallow function in children with suspected aspiration using pharyngeal automated impedance manometry.
abstract: OBJECTIVE
  The purpose of the present study was to apply a new method, pharyngeal automated impedance manometry (AIM), as an objective assessment tool of swallow function relevant to aspiration, in a cohort of paediatric patients with dysphagia.
  
  
  METHODS
  We studied 20 children (mean age 6 years [5 months to 13.4 years]) referred for videofluoroscopy to assess aspiration risk with simultaneous manometry-impedance. Fluoroscopic evidence of aspiration was scored using a validated aspiration-penetration score. Pressure-flow profiles were analysed using AIM analysis measuring peak pressure, pressure at nadir impedance, time from nadir impedance to peak pressure, and flow interval. These variables were combined into a swallow risk index (SRI).
  
  
  RESULTS
  Six of 20 children presented with deglutitive aspiration during videofluoroscopic assessment of swallowing. Of 58 liquid swallows analysed, in 9 aspiration was observed. Multiple logistic regression identified longer flow interval (P < 0.05), higher SRI (P < 0.05) and increased pressure in the upper oesophageal sphincter during maximal bolus flow (P < 0.05) to be the dominant risk variables predictive of aspiration in children. Each of these nonradiologically derived pressure-flow variables correlated with higher aspiration scores on videofluoroscopy (P < 0.01).
  
  
  CONCLUSIONS
  We present novel, preliminary findings in children with deglutitive aspiration, suggesting that pharyngeal AIM can detect alterations in pressure-flow characteristics of swallowing that predispose to aspiration risk.
authors.affiliation: *Neurosciences, ExpORL, Faculty of Medicine †Translational Research Centre for Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium ‡Faculty of Health Sciences, Flinders University School of Medicine, Bedford Park, Australia §Pediatric Gastroenterology, Hepatology, and Nutrition ||Radiology, University Hospital Leuven, Leuven, Belgium ¶School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rommel
authors.forename: Margot
authors.initials: M
authors.lastname: Selleslagh
authors.forename: Ilse
authors.initials: I
authors.lastname: Hoffman
authors.forename: Maria H
authors.initials: MH
authors.lastname: Smet
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Davidson
authors.forename: Jan
authors.initials: J
authors.lastname: Tack
authors.forename: Taher Imad
authors.initials: TI
authors.lastname: Omari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology*; D017097:Electric Impedance; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008365:Manometry / Q000379:methods; D010614:Pharynx / Q000502:physiology*; D011312:Pressure; D012306:Risk