Fig. 11.1
(a) HRM color plot of a normal liquid swallow in a 5-year-old child. Pressure is an indication according to color code illustrated. (b) Lateral radiological view of the pharynx and UES showing the transnasal placement of the HRM solid-state catheter in a 5- and 11-year-old child
Fig. 11.2
HRM plot illustrating adequate UES relaxation and a hypocontractile pharynx in a 2-year-old patient presenting with dysphagia on liquids. Radiology shows post-swallow residue in the piriform sinus and poor UES opening secondary to poor pharyngeal bolus propulsion despite complete UES relaxation
Fig. 11.3
UES dysfunction in a 4-year-old girl with CP presenting with chronic dysphagia and recurrent aspiration pneumonia. Increased pharyngeal intrabolus pressure as a result of resistance to bolus flow across a non-relaxing UES. This example illustrates that intrabolus pressure can only occur when pharyngeal pressures are intact. Naso-oropharyngeal contractions fail in this patient and intrabolus pressure cannot be determined
Summary
Regardless of the primary medical pathology, it is crucial to assess the core biomechanics of swallow physiology with assessment techniques which are as objective as possible. Incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies for infants and children with dysphagia. Recent advances using different instrumental technologies are promising and need ongoing validation in the pediatric population.
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