Original research| Volume 98, ISSUE 3, P487-494, March 2017

Effect of Different Viscosities on Pharyngeal Pressure During Swallowing: A Study Using High-Resolution Manometry

  • Donghwi Park
    Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
    Search for articles by this author
  • Cheol Min Shin
    Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
    Search for articles by this author
  • Ju Seok Ryu
    Corresponding author Ju Seok Ryu, MD, PhD, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
    Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
    Search for articles by this author
Published:August 11, 2016DOI:



      To investigate and compare the mechanism of swallowing with respect to the viscosity of ingested material between patients with and without dysphagia.


      Prospectively collected and retrospectively analyzed clinical study.


      General teaching hospital, rehabilitation unit.


      We retrospectively reviewed the high-resolution manometry (HRM) results of 35 patients with dysphagia symptoms (N=35). Additionally, we included 18 patients without dysphagia. Based on videofluoroscopic swallowing study results, we classified the patients into 2 groups: one with aspiration and the other without aspiration.


      Swallowing of a 5-mL thin liquid and 5-mL honey-like liquid in all patients.

      Main Outcome Measure

      HRM of various variables during the swallowing process.


      There was no significant difference between the thin liquid and honey-like liquid with respect to parameters for HRM in the patients without dysphagia and in the nonaspiration and aspiration groups. However, in a comparison between thin liquid and honey-like liquid with respect to visuospatial and timing variables, the degree of differences in the maximal pressure of the velopharynx in the aspiration group was significantly larger than the patients without dysphagia and the nonaspiration group (P<.05).


      Our results indicate that there is a clear difference in the degree of adaptation to viscosity between the 3 groups—patients without dysphagia, patients with aspiration, and patients without aspiration. These differences may provide an explanation for the mechanism of swallowing, which may be useful for the treatment of dysphagia.


      List of abbreviations:

      HRM (high-resolution manometry), UES (upper esophageal sphincter), VFSS (videofluoroscopic swallowing study)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lan Y.
        • Xu G.
        • Dou Z.
        • Lin T.
        • Yu F.
        • Jiang L.
        The correlation between manometric and videofluoroscopic measurements of the swallowing function in brainstem stroke patients with dysphagia.
        J Clin Gastroenterol. 2015; 49: 24-30
        • Kendall K.A.
        • Leonard R.J.
        • McKenzie S.W.
        Accommodation to changes in bolus viscosity in normal deglutition: a videofluoroscopic study.
        Ann Otol Rhinol Laryngol. 2001; 110: 1059-1065
        • Choi K.H.
        • Ryu J.S.
        • Kim M.Y.
        • Kang J.Y.
        • Yoo S.D.
        Kinematic analysis of dysphagia: significant parameters of aspiration related to bolus viscosity.
        Dysphagia. 2011; 26: 392-398
        • Lazarus C.L.
        • Logemann J.A.
        • Rademaker A.W.
        • et al.
        Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients.
        Arch Phys Med Rehabil. 1993; 74: 1066-1070
        • Clave P.
        • de Kraa M.
        • Arreola V.
        • et al.
        The effect of bolus viscosity on swallowing function in neurogenic dysphagia.
        Aliment Pharmacol Ther. 2006; 24: 1385-1394
        • Lee S.I.
        • Yoo J.Y.
        • Kim M.
        • Ryu J.S.
        Changes of timing variables in swallowing of boluses with different viscosities in patients with dysphagia.
        Arch Phys Med Rehabil. 2013; 94: 120-126
        • Butler S.G.
        • Stuart A.
        • Castell D.
        • Russell G.B.
        • Koch K.
        • Kemp S.
        Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing.
        J Speech Lang Hear Res. 2009; 52: 240-253
        • Perlman A.L.
        • Schultz J.G.
        • VanDaele D.J.
        Effects of age, gender, bolus volume, and bolus viscosity on oropharyngeal pressure during swallowing.
        J Appl Physiol (1985). 1993; 75: 33-37
        • Mielens J.D.
        • Hoffman M.R.
        • Ciucci M.R.
        • Jiang J.J.
        • McCulloch T.M.
        Automated analysis of pharyngeal pressure data obtained with high-resolution manometry.
        Dysphagia. 2011; 26: 3-12
        • Park D.
        • Oh Y.
        • Ryu J.S.
        Findings of abnormal videofluoroscopic swallowing study identified by high-resolution manometry parameters.
        Arch Phys Med Rehabil. 2016; 97: 421-428
        • Ryu J.S.
        • Park D.
        • Oh Y.
        • Lee S.T.
        • Kang J.Y.
        The effects of bolus volume and texture on pharyngeal pressure events using high-resolution manometry and its comparison with videofluoroscopic swallowing study.
        J Neurogastroenterol Motil. 2016; 22: 231-239
        • Kim C.K.
        • Ryu J.S.
        • Song S.H.
        • et al.
        Effects of head rotation and head tilt on pharyngeal pressure events using high resolution manometry.
        Ann Rehabil Med. 2015; 39: 425-431
        • Rosenbek J.C.
        • Robbins J.A.
        • Roecker E.B.
        • Coyle J.L.
        • Wood J.L.
        A penetration-aspiration scale.
        Dysphagia. 1996; 11: 93-98
        • Fox M.R.
        • Bredenoord A.J.
        Oesophageal high-resolution manometry: moving from research into clinical practice.
        Gut. 2008; 57: 405-423
        • Umeki H.
        • Takasaki K.
        • Enatsu K.
        • Tanaka F.
        • Kumagami H.
        • Takahashi H.
        Effects of a tongue-holding maneuver during swallowing evaluated by high-resolution manometry.
        Otolaryngol Head Neck Surg. 2009; 141: 119-122
        • Ryu J.S.
        • Park D.H.
        • Kang J.Y.
        Application and interpretation of high-resolution manometry for pharyngeal dysphagia.
        J Neurogastroenterol Motil. 2015; 21: 283-287
        • Hoffman M.R.
        • Jones C.A.
        • Geng Z.
        • et al.
        Classification of high-resolution manometry data according to videofluoroscopic parameters using pattern recognition.
        Otolaryngol Head Neck Surg. 2013; 149: 126-133
        • McCallum S.L.
        The national dysphagia diet: implementation at a regional rehabilitation center and hospital system.
        J Am Diet Assoc. 2003; 103: 381-384
        • Strowd L.
        • Kyzima J.
        • Pillsbury D.
        • Valley T.
        • Rubin B.
        Dysphagia dietary guidelines and the rheology of nutritional feeds and barium test feeds.
        Chest. 2008; 133: 1397-1401
        • Ryu J.S.
        • Lee J.H.
        • Kang J.Y.
        • Kim M.Y.
        • Shin D.E.
        • Shin D.A.
        Evaluation of dysphagia after cervical surgery using laryngeal electromyography.
        Dysphagia. 2012; 27: 318-324
        • Uhm K.E.
        • Yi S.H.
        • Chang H.J.
        • Cheon H.J.
        • Kwon J.Y.
        Videofluoroscopic swallowing study findings in full-term and preterm infants with dysphagia.
        Ann Rehabil Med. 2013; 37: 175-182
        • Mielens J.D.
        • Hoffman M.R.
        • Ciucci M.R.
        • McCulloch T.M.
        • Jiang J.J.
        Application of classification models to pharyngeal high-resolution manometry.
        J Speech Lang Hear Res. 2012; 55: 892-902
        • Yamamura K.
        • Kitagawa J.
        • Kurose M.
        • et al.
        Neural mechanisms of swallowing and effects of taste and other stimuli on swallow initiation.
        Biol Pharm Bull. 2010; 33: 1786-1790
        • Steele C.M.
        • Alsanei W.A.
        • Ayanikalath S.
        • et al.
        The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review.
        Dysphagia. 2015; 30: 2-26
        • Logemann J.A.
        Noninvasive approaches to deglutitive aspiration.
        Dysphagia. 1993; 8: 331-333