Multimodal Assessment of Cricopharyngeal Dysfunction: A Protocol Using Videofluoroscopic Swallowing Study, Flexible Endoscopic Evaluation of Swallowing, and High-Resolution Manometry

Background Cricopharyngeal dysfunction (CPD), defined as impaired relaxation of the upper esophageal sphincter, may lead to difficulty swallowing, oropharyngeal residue, aspiration, and morbidity. It is often a feature of dystonia, post-stroke spasticity, and other diseases associated with increased muscle tone and is an under-recognized cause of neurogenic dysphagia. We describe a comprehensive approach to evaluating CPD. Objectives To describe the evaluation of neurogenic CPD, using a multimodal assessment protocol including Clinical swallow assessment, videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), and high-resolution esophageal manometry. Methods Patients with neurogenic dysphagia undergo a structured multimodal assessment comprising clinical swallow evaluation, VFSS with standardized liquid and semisolid boluses, FEES with pharyngeal squeeze maneuver, and high-resolution esophageal manometry to characterize upper esophageal sphincter function and pharyngeal swallowing physiology. Discussion A multimodal protocol incorporating clinical swallow assessment, VFSS, FEES, and high-resolution esophageal manometry provides a reproducible and comprehensive approach to the accurate diagnosis of CPD.