Abstract: Neurogenic dysphagia is characterized by high incidence, significant risk of aspiration, and strong phenotypic heterogeneity. Traditional video fluoroscopic swallowing studies (VFSS) and fiberoptic endoscopic swallowing studies (FEES) focus on morphological observation and cannot quantify the biomechanical mechanisms of swallowing. High-resolution manometry (HRM) enables precise capture of pressure changes throughout the entire pharyngoesophageal tract; high-resolution impedance manometry (HRIM), combined with impedance techniques, allows simultaneous evaluation of food bolus transport efficiency and upper esophageal sphincter (UES) compliance, effectively addressing the limitations of pure pressure monitoring in functional assessment. This article reviews the applications of HRM/HRIM in conditions such as stroke, Parkinson's disease, and motor neuron diseases, summarizing characteristic pressure phenotypes and their clinical implications for classification and individualized treatment. On this basis, this review analyzes the current challenges faced by pharyngeal HRM in clinical translation, including the lack of a normative reference value system, unestablished diagnostic thresholds, and limited evidence-based data. The 2025 Leuven Consensus provides a preliminary framework for the standardized application of this technique. However, future efforts are still needed to establish a normative database for the Chinese population through multicenter studies, introduce artificial intelligence-assisted interpretation, and promote the development of portable devices, so as to facilitate the substantive translation of HRM/HRIM from research tools to routine clinical practice..