High-resolution manometry (HRM)

Our guidance on High-resolution manometry can be found on these pages. Associated RCSLT guidance on Eating, drinking and swallowing as well as associated frameworks on FEES and competencies, are also available

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(Last updated September 2025)

Position Paper

This position paper defines best practice for the use of the instrumental assessment HRM. It explores the evidence base, context and practical considerations when operating an SLT led HRM service.

Read the position paper 

Competency framework

The competency framework is for SLTs working with service users with eating, drinking and swallowing difficulties who have been referred for an SLT led HRM assessment.

Download  the HRM competency framework

This is a UK-wide document and is an adjunct to the RCSLT SLT EDS competency framework and the RCSLT professional development framework.

Research and evidence

Further resources will be added to this page as they are developed and shared.

Guidelines and Protocols

Omari, T. I., Maclean, J. C. F., Cock, C., McCulloch, T. M., Nativ-Zeltzer, N., O’Rourke, A. K., Szczesniak, M. M., Wu, P. I., Allen, J., Aoyai, Y., Bayona, H. H. G., Carrión, S., Ciucci, M. R., Davidson, K., Dhar, S. I., Hamdy, S., Howell, R., Jones, C., Knigge, M. A., Moonen, A., Postma, G. N., Puntil-Sheltman, J., Rameau, A., Regan, J., Schar, M. & Rommel, N. (2025) Defining pharyngeal and upper esophageal sphincter disorders on high-resolution manometry-impedance: The Leuven consensus. Neurogastroenterology & Motility, n/a, e70042. https://doi.org/10.1111/nmo.70042

Omari, T.I., Ciucci, M., Gozdzikowska, K., Hernández, E., Hutcheson, K., Jones, C., Maclean, J., Nativ-Zeltzer, N., Plowman, E., Rogus-Pulia, N., Rommel, N. and O’Rourke, A. (2020) High-resolution pharyngeal manometry and impedance: Protocols and metrics—Recommendations of a high-resolution pharyngeal manometry international working group. Dysphagia, 35(2), pp.281-295. https://DOI.org/10.1007/s00455-019-10023-y

Sibley, H., Miller, K., Davidson, K. and O’Rourke, A. (2023) High-resolution pharyngeal manometry: Recent developments and future directions. Current otorhinolaryngology reports, 11(3), pp.374-380. https://DOI.org/10.1007/s40136-023-00461-6

Oesophageal HRM- Chicago Classification V4

Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, Babaei A, Mittal RK, Rommel N, Savarino E, Sifrim D, Smout A, Vaezi MF, Zerbib F, Akiyama J, Bhatia S, Bor S, Carlson DA, Chen JW, Cisternas D, Cock C, Coss-Adame E, de Bortoli N, Defilippi C, Fass R, Ghoshal UC, Gonlachanvit S, Hani A, Hebbard GS, Wook Jung K, Katz P, Katzka DA, Khan A, Kohn GP, Lazarescu A, Lengliner J, Mittal SK, Omari T, Park MI, Penagini R, Pohl D, Richter JE, Serra J, Sweis R, Tack J, Tatum RP, Tutuian R, Vela MF, Wong RK, Wu JC, Xiao Y, Pandolfino JE. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©.(2024) Neurogastroenterol Motil. 2021 Jan;33(1):e14058. doi: 10.1111/nmo.14058. Erratum in: Neurogastroenterol Motil. Feb;36(2):e14179. https://doi.org/10.1111/nmo.14058

 

 

SLT Led HRM – Clinical implementation

Cheriyan, S.S., Schar, M., Woods, C.M., Szczesniak, M., Cock, C., Omari, T.I., Athanasiadis, T. and Ooi, E.H. (2023) Clinical application of pharyngeal high-resolution manometry in Ear, Nose and Throat (ENT) practice. Australian journal of otolaryngology, 6; 4. https://DOI.org/10.21037/ajo-22-37

Davidson, K. and O’Rourke, A.K. (2019) The utility of high-resolution pharyngeal manometry in dysphagia treatment. Perspectives of the ASHA special interest groups, 4(3), pp.507-516. https://doi.org/10.1044/2019_PERS-SIG13-2018-0027

Davidson, K., O’Rourke, A., Fortunato, J.E. and Jadcherla, S. (2020) The emerging importance of high-resolution manometry in the evaluation and treatment of deglutition in infants, children, and adults: New opportunities for speech-language pathologists. American Journal of Speech-Language pathology, 29(2S), pp.945-955. https://DOI.org/10.1044/2019_AJSLP-19-00067

Jones, C.A., Forgues, A.L., Rogus-Pulia, N.M., Orne, J., Macdonald, C.L., Connor, N.P. and McCulloch, T.M. (2019a) Correlates of early pharyngeal high-resolution manometry adoption in expert speech-language pathologists. Dysphagia, 34(3), pp.325-332. https://DOI.org/10.1007/s00455-018-9941-4

Jones, C.A., Hoffman, M.R., Geng, Z., Abdelhalim, S.M., Jiang, J.J. and McCulloch, T.M. (2014) Reliability of an automated high-resolution manometry analysis program across expert users, novice users, and speech-language pathologists. Journal of speech, language, and hearing research, 57(3), pp.831-836. https://DOI.org/10.1044/2014_JSLHR-S-13-0101

Jones, C.A., Lagus, J.F., Abdelhalim, S.M., Osborn, C.M., Colevas, S.M. and McCulloch, T.M. (2024) Normative high-resolution pharyngeal manometry: Impact of age, size of system, and sex on primary metrics and pressure stability. Dysphagia, 39(4), pp.648-665. https://DOI.org/10.1007/s00455-023-10647-1

Jones, C.A., Rogus-Pulia, N.M., Forgues, A.L., Orne, J., Macdonald, C.L., Connor, N.P. and McCulloch, T.M. (2019b) SLP-perceived technical and patient-centered factors associated with

pharyngeal high-resolution manometry. Dysphagia, 34(2), pp.170-178. https://doi.org/10.1007/s00455-018-9954-z

Knigge, M.A., Marvin, S. and Thibeault, S.L. (2019) Safety and tolerability of pharyngeal high-resolution manometry. American journal of speech-language pathology, 28(1), pp.43-52. https://doi.org/10.1044/2018_AJSLP-18-0039

Knigge, M.A., Thibeault, S. and McCulloch, T.M. (2014) Implementation of high-resolution manometry in the clinical practice of speech language pathology. Dysphagia, 29(1), pp.2-16. https://DOI.org/10.1007/s00455-013-9494-5

Omari, T., Szczesniak, M., Rommel, N., Cock, C., Schar, M., Woods, C.M., Athanasiadis, T. and Ooi, E.H. (2023) Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders. Neurogastroenterology & motility, 35(1), e14461. https://DOI.org/10.1111/nmo.14461

 

 

Biofeedback and dysphagia therapy

Heslin, N. and Regan, J. (2022) Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study. International journal of speech-language pathology, 24(2), pp.190-199. https://DOI.org/10.1080/17549507.2021.1975817

Huckabee M-L, Lamvik K, Jones R. (2014) Pharyngeal mis-sequencing in dysphagia: Characteristics, rehabilitative response, and etiological speculation. J Neurol Sci. ;343(1):153–8. https://doi.org/10.1016/j.jns.2014.05.064.

O’Rourke, A. and Humphries, K. (2017) The use of high-resolution pharyngeal manometry as biofeedback in dysphagia therapy. Ear, nose and throat journal, 96(2), pp.56 https://DOI.org/10.1177/014556131709600205

Sibley, H., Miller, K., Davidson, K. and O’Rourke, A. (2023) High-resolution pharyngeal manometry: Recent developments and future directions. Current otorhinolaryngology reports, 11(3), pp.374-380. https://DOI.org/10.1007/s40136-023-00461-6