Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in Patients With Unilateral Vocal Fold Immobility: Incidence and Pathophysiology of Aspiration

Tabaee, Abtin; Murry, Thomas; Zschommler, Anne; Desloge, Rosemary B.

doi:10.1097/01.mlg.0000161358.20450.12

Cited by 74 publications

(87 citation statements)

References 10 publications

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“…Previous studies have reported that nearly 56% of patients with VCP have swallowing dysfunction [4, 5]. Tabaee et al [6] suggested that dysphagia in patients with VCP has multifactorial causes, including limited airway protection and decreased laryngopharyngeal sensation based on the findings of flexible endoscopy. Heitmiller et al [7] asserted that aspiration resulted from impaired airway protection rather than esophageal obstruction in patients with unilateral vocal fold motion impairment, and recommended video pharyngoesophagography as the technique of choice to identify patients at risk for aspiration.…”

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confidence: 99%

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

et al. 2011

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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.

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confidence: 99%

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

et al. 2011

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“…However, this has been little studied in the clinical literature. Both work on breathing [37] and dysphagia [38,39] are inconclusive with regard to the effect of resting position of the paralyzed vocal fold on impairment.…”

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confidence: 99%

The Physiologic Impact of Unilateral Recurrent Laryngeal Nerve (RLN) Lesion on Infant Oropharyngeal and Esophageal Performance

et al. 2015

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Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that 1) both airway protection and esophageal function would be compromised by lesion, 2) given our design, variability between multiple post-lesion trials would be minimal, 3) variability among individuals would be minimal. Individuals' swallowing performance was assessed pre- and post-lesion using high speed VFSS. Aspiration was assessed using the Infant Mammalian Penetration Aspiration Scale (IMPAS). Esophageal function was assessed using two measures devised for this study. Our results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels. On average, aspiration worsened with time post-lesion. Within a single feeding sequence, the distribution of unsafe swallows varied. Individuals changed post-lesion either by increasing average IMPAS score, or by increasing variation in IMPAS score. Unilateral RLN transection resulted in dysphagia with both compromised airway protection and esophageal function. Despite consistent, experimentally controlled injury, significant variation in response to lesion remained. Aspiration following RLN lesion was due to more than unilateral vocal fold paralysis. We suggest that neurological variation underlies this pattern.

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“…The prevalence of aspiration among patients with UVFI is 18-38 % [ [47][48][49]. Therefore, if a patient complains of dysphagia, or aspiration is suspected, further evaluation of their swallowing function should be performed.…”

Section: Formal Evaluation Of Swallowingmentioning

confidence: 99%

Evaluation of Unilateral Vocal Fold Immobility

Kupfer

Meyer

2014

Curr Otorhinolaryngol Rep

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Unilateral vocal fold immobility (UFVI) is a highly variable clinical entity that may be neurogenic or mechanical in origin. Patients with UVFI have varying degrees of voice, swallowing, and airway disturbance. The patient should be carefully evaluated, including thorough history, head, neck, and neurologic examination, and laryngoscopy, to determine the etiology of UFVI and the current level of laryngeal function. If the etiology cannot be determined, cross sectional imaging of the skull base through the mediastinum is recommended to evaluate the underlying cause. Laryngeal electromyography is most useful for predicting poor functional recovery and may affect the decision to proceed with early definitive surgical management. Formal swallowing testing is indicated for patients with dysphagia to identify aspiration.

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Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in Patients With Unilateral Vocal Fold Immobility: Incidence and Pathophysiology of Aspiration

Cited by 74 publications

References 10 publications

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

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

The Physiologic Impact of Unilateral Recurrent Laryngeal Nerve (RLN) Lesion on Infant Oropharyngeal and Esophageal Performance

Evaluation of Unilateral Vocal Fold Immobility

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