High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics—Recommendations of a High-Resolution Pharyngeal Manometry International Working Group

Taher I. Omari, Michelle Ciucci, Kristin Gozdzikowska, Ester Hernández, Katherine Hutcheson, Corinne Jones, Julia Maclean, Nogah Nativ-Zeltzer, Emily Plowman, Nicole Rogus-Pulia, Nathalie Rommel, Ashli O’Rourke*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


High-resolution manometry has traditionally been utilized in gastroenterology diagnostic clinical and research applications. Recently, it is also finding new and important applications in speech pathology and laryngology practices. A High-Resolution Pharyngeal Manometry International Working Group was formed as a grass roots effort to establish a consensus on methodology, protocol, and outcome metrics for high-resolution pharyngeal manometry (HRPM) with consideration of impedance as an adjunct modality. The Working Group undertook three tasks (1) survey what experts were currently doing in their clinical and/or research practice; (2) perform a review of the literature underpinning the value of particular HRPM metrics for understanding swallowing physiology and pathophysiology; and (3) establish a core outcomes set of HRPM metrics via a Delphi consensus process. Expert survey results were used to create a recommended HRPM protocol addressing system configuration, catheter insertion, and bolus administration. Ninety two articles were included in the final literature review resulting in categorization of 22 HRPM-impedance metrics into three classes: pharyngeal lumen occlusive pressures, hypopharyngeal intrabolus pressures, and upper esophageal sphincter (UES) function. A stable Delphi consensus was achieved for 8 HRPM-Impedance metrics: pharyngeal contractile integral (CI), velopharyngeal CI, hypopharyngeal CI, hypopharyngeal pressure at nadir impedance, UES integrated relaxation pressure, relaxation time, and maximum admittance. While some important unanswered questions remain, our work represents the first step in standardization of high-resolution pharyngeal manometry acquisition, measurement, and reporting. This could potentially inform future proposals for an HRPM-based classification system specifically for pharyngeal swallowing disorders.

Original languageEnglish
Pages (from-to)281-295
Number of pages15
Issue number2
StatePublished - 1 Apr 2020
Externally publishedYes


FundersFunder number
Barbara Messing
Greater Baltimore Medical Center
University of Wisconsin
Veterans Administration Hospital
National Institute of Neurological Disorders and StrokeR01NS100859
University of Florida
Johns Hopkins University
University of Central Florida
University of Auckland
University of New South Wales
Flinders University


    • Deglutition
    • Deglutition disorders
    • Dysphagia
    • High-resolution manometry
    • Intraluminal impedance
    • Pharynx


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