Laryngopharyngeal sensation is important in the normal process of swallowing, it is often impaired after neurological events and it has been common practice in such an occurrence to order non-oral tube feeding to prevent aspiration. This study assesses a novel approach to the evaluation of the laryngopharyngeal sensation that allows for improved triage of aspiration risk and more lenience towards oral feeding. This is a case series with follow-up period ranging from 6 to 24 months. Forty patients with neurological deficiencies were tested by a modified laryngopharyngeal sensation study that included evaluation of both supra and infra-glottis. All patients had impaired supra glottic sensation but had good infra glottic sensation that enabled cough protection. All had received oral feeding. Main outcome measure is incident aspiration pneumonia. Twenty-two patients maintained oral feeding without any evidence of aspiration. Eighteen patients had some aspirations associated with cough, and were maintained on modified oral feeding. Out of these 18 patients, four patients (10% of the entire group) developed aspiration pneumonia. The presented procedure identified patients with impaired supraglottic sensation but preserved good infra glottic sensation. This observation enables safe oral feeding in most patients and therefore offers a better quality of life for these individuals.

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Health problems among people with intellectual and developmental disabilities (I/DD) are considered more prevalent than among the general population, but there are very few studies that have described a detailed ear, nose, and throat examination of this group. The purpose of this paper is to provide a set of guidelines that can result in a structured ear, nose, and throat examination, describe one experience with implementing the guidelines for otorhinolaryngological care with a heteroegnous sample of adults with intellectual disability, discuss relevant care principles derived from the experience, and specifically address the issue of cerumen impaction. The subjects, 356 adult residents of two residential care centers for people with I/DD, were examined by four otolaryngologists, assisted by an audiologist/speech-language pathologist, and a nurse. The examinations lasted 8 h over 2 days. Of the residents, 292 (82%) had at least one main finding; impacted cerumen was observed among 54.9% of the examined ears. Of these, 103 residents (206 ears) were examined again after cerumenolytic treatment and cerumen cleared. The authors concluded that there is a need for focused physical examination in order to recognize and treat ear, nose, and throat disorders in this population. Examinations of adults with I/DD are feasible and important in enabling good communication and maintaining general health.