Analysis of Video Fluoroscopic Swallowing Study in Patients with Vocal Cord Paralysis

Abstract

We reviewed the findings of a video fluoroscopic swallowing study (VFSS) of 28 patients with vocal cord paralysis (VCP) who complained of swallowing difficulties. VFSSs were performed with thick and thin liquid using modified Logemann methods. The patients were grouped according to whether their VCP was of central or peripheral origin, and the VFSS findings of the groups were compared. The patients showed oral phase dysfunction and pharyngeal dysfunction, especially when the cause was of central origin. Oral phase abnormalities were found in 13 patients and pharyngeal phase abnormalities were found in all patients, including penetration in 20 patients and aspiration in 14 patients. Improper lip closure (LC) and bolus formation (BF) and a delay in triggering pharyngeal swallow (TPS) and upper esophageal sphincter release (UESR) were significantly more frequent in patients with central VCP. With thin-liquid swallowing, pharyngeal transit time (PTT) and pharyngeal delay time (PDT) were significantly more prolonged in central VCP. The results suggest that the delay in triggering and poor coordination of swallowing were profound in patients with central VCP, but dysfunction in peripheral VCP may originate from poor pharyngeal movement.

Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility

“…The results of the present study confirm the qualitative findings of Jang et al with objective data. In that study, individuals with UVFI of peripheral origin (i.e., recurrent laryngeal nerve injury, vagus nerve injury, or idiopathic etiologies) presented with subjective suggestion of abnormal laryngeal elevation and epiglottic inversion, residue in the valleculae, residue in the pyriform sinuses, and aspiration …”

“…If airway protection is ineffective, an individual may aspirate material into the lungs, which may result in respiratory infection and/or death due to aspiration pneumonia. Approximately 33% to 42% of individuals with UVFI have been identified to aspirate . Diminished airway protection is presumed to be the primary cause of swallowing dysfunction in patients with UVFI .…”

“…This has been hypothesized in previous studies, which have demonstrated subjective findings in addition to impaired glottic closure that the authors stated contributed to a patient's increased risk of aspiration. One study that included patients with UVFI of both central and peripheral origins identified poor pharyngeal movement in patients with peripheral (i.e., recurrent laryngeal nerve injury, vagus nerve injury, or idiopathic etiologies) UVFI . Another study identified decreased sensation as a contributing factor to aspiration .…”

Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis

“…63–65 Therefore, pre-operative evaluation should inquire into whether affected patients have had pneumonia and/or have noticed increased liquid or solid food dysphagia since symptom onset. 66,67 In these situations, swallow assessment (e.g.…”

“…modified barium swallow study) is helpful to characterize the degree of penetration, aspiration, any abnormalities at the cricopharyngeus, and to teach and reinforce safe swallowing maneuvers. 65 Aeroacoustic and pulmonary function studies are used by some to measure glottic airflow rates and glottic resistance, but are considered supplemental by most surgeons.…”