Clinical evaluation and treatment for swallowing disorders has historically relied on subjective judgments of imaging studies, contributing to highly variable interpretation of physiologic events. Technologic advancements in manometry systems have introduced high-resolution manometry as a complementary assessment and treatment tool in complex pharyngeal dysphagia. This chapter will acquaint the reader with high-resolution manometry, outline the evidence supporting its use in pharyngeal dysphagia, define a practice model for clinical application, and propose neurologic conditions where high-resolution pharyngeal manometry can enhance both evaluation and treatment of neurogenic dysphagia.