Validation of a Low-Cost Manometer to Assess of Tongue, Lip, Cheek, and Respiratory Strength: A Laboratory-Based Study.

OBJECTIVE(S): The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer.

METHODS

Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρ < 0.90, "moderate" if ρ = 0.90 - < 0.95, "substantial" if ρ = 0.95 - < 0.99, and "excellent" if ρ ≥ 0.99.

RESULTS

Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm HO between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρ = 0.98) and the MicroRPM and DPM (ρ = 0.99).

CONCLUSION

The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:263-269, 2025.