# Defining novel pharyngeal pressure metrics to predict dysphagia treatment outcomes and clinical prognosis using high-resolution manometry

> **NIH VA I01** · WM S. MIDDLETON MEMORIAL VETERANS HOSP · 2021 · —

## Abstract

Oropharyngeal dysphagia, or difficulty swallowing, is a devastating condition that affects physiological and
psychosocial functioning in 1 in 25 adults. In 2016, speech-language pathologists working in the VA completed
more than 102,905 evaluation and 77,786 treatment procedures for oropharyngeal dysphagia. This highlights
not only the incidence of suspected dysphagia in the Veteran population but also the substantial need for
dysphagia management with appropriate outcomes tracking. Many dysphagia treatments exist, but our ability
to adequately measure treatment outcomes is limited. Pharyngeal high-resolution manometry (pHRM) directly
measures swallowing pressures, providing an objective measurement of physiology that characterizes the
basic mechanisms of swallowing. pHRM is well-poised to measure outcomes of dysphagia treatments due to
its direct, objective, and reproducible measures of swallowing function. We propose that adding pHRM to
standard assessments will help address three current issues: 1) lack of objective measures to accurately
monitor treatment effects; 2) uncertainty of how physiological measures relate to patient-reported outcome
measures; and 3) absence of prognostic algorithms that predict treatment effects. This proposed project will
address our central hypotheses that objective swallowing measures (including pHRM) will reveal treatment-
mediated swallowing changes, will align with outcome measures, and will be able to predict who will benefit
from treatment.
This multi-center prospective study will follow a cohort of Veterans with dysphagia (n=150) for 8 weeks as they
undergo clinically guided oropharyngeal exercises with oropharyngeal strengthening as the primary goal.
Veterans with dysphagia will be assessed at three time points: baseline, 4 weeks after treatment initiation, and
8 weeks after treatment initiation. A non-dysphagic Veteran control group (n=50) will also undergo data
collection at parallel time points, without completion of a treatment paradigm. We will then compare patients to
non-dysphagic controls using pHRM, videofluoroscopy, diet assessment, functional reserve tests, and patient-
reported outcome measures. We aim to 1) quantify change in pHRM measures of swallowing function resulting
from dysphagia treatment; 2) determine which combination of standard of care and/or pHRM-based metrics
best track with outcome measures; and 3) develop multimodal prognostic algorithms that predict treatment
success. This research will establish a precise outcome measurement paradigm suitable for dysphagia clinical
care and research, thus improving clinical confidence and paving the way for a personalized medicine
approach for dysphagia rehabilitation in Veterans.

## Key facts

- **NIH application ID:** 10070440
- **Project number:** 1I01RX003221-01A2
- **Recipient organization:** WM S. MIDDLETON MEMORIAL VETERANS HOSP
- **Principal Investigator:** Timothy M McCulloch
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10070440

## Citation

> US National Institutes of Health, RePORTER application 10070440, Defining novel pharyngeal pressure metrics to predict dysphagia treatment outcomes and clinical prognosis using high-resolution manometry (1I01RX003221-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10070440. Licensed CC0.

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