Share this article on:

Objective Assessment of Swallow Function in Children With Suspected Aspiration Using Pharyngeal Automated Impedance Manometry

Rommel, Nathalie*; Selleslagh, Margot*; Hoffman, Ilse§; Smet, Maria H.||; Davidson, Geoffrey; Tack, Jan; Omari, Taher Imad

Journal of Pediatric Gastroenterology & Nutrition: June 2014 - Volume 58 - Issue 6 - p 789–794
doi: 10.1097/MPG.0000000000000337
Original Articles: Gastroenterology

Objectives: 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.

*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.

Address correspondence and reprint requests to Prof Nathalie Rommel, Department of Neurosciences, ExpORL, KU Leuven, Herestraat 49, PO Box 721, 3000 Leuven, Belgium (e-mail:

Received 4 February, 2014

Accepted 4 February, 2014

The present research was supported by a FWO doctoral fellowship to M. Selleslagh and a Methusalem Grant to Prof J. Tack, University of Leuven, Belgium. It was also supported by the Thrasher Research Fund, NHMRC Grant No. 1009344 Women's and Children's Hospital Foundation, Australia.

N.R. has a patent from AIM Technology. T.I.O. has received funding from and has been a consultant to Sandhill Scientific, and has a patent from AIM Technology. The other authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,