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

Domer, Amanda S.; Leonard, Rebecca J.; Belafsky, Peter C.

doi:10.1002/lary.24779

Cited by 37 publications

(36 citation statements)

References 8 publications

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“…2,7,[17][18][19] Patients suffering from multiple cranial neuropathies or central nervous system dysfunction may receive less benefit from medialization procedures given multiple levels of laryngeal dysfunction. 16 Despite the etiologic homogeneity of our study population, our findings remain pertinent as surgical trauma to the RLN is the most commonly cited etiology of UVFI. 16 Interestingly, 57% of patients in our study did not have aspiration associated with their dysphagia.…”

Section: Discussionmentioning

confidence: 75%

“…16 Despite the etiologic homogeneity of our study population, our findings remain pertinent as surgical trauma to the RLN is the most commonly cited etiology of UVFI. 16 Interestingly, 57% of patients in our study did not have aspiration associated with their dysphagia. Why some patients experience aspiration with UVFI while others do not also remains poorly understood.…”

Section: Discussionmentioning

confidence: 75%

“…15 Domer et al demonstrated significantly prolonged pharyngeal transit time and decreased pharyngeal strength in patients with UVFI, thus supporting the notion that mechanical factors other than glottal competence contribute to the increased incidence of penetration and aspiration in this patient population. 16 Because swallowing is a complex, multistep process that requires various motor and sensory inputs, swallow outcomes after medialization procedures in patients with UVFI have yielded diverse results. The findings of our study suggest a greater derived benefit than in several prior studies.…”

Section: Discussionmentioning

confidence: 99%

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Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

2018

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While the impact of injection laryngoplasty on voice outcomes in unilateral vocal fold immobility has been well characterized, there is a relative paucity of literature investigating its influence on swallow function and outcomes. We performed a retrospective chart review of patients presenting to an academic cancer center between January 2014 and January 2016 to evaluate the clinical impact of percutaneous injection laryngoplasty on reduction of aspiration risk, patient perception of swallowing, and recommended safe diet in patients with vocal fold immobility after head and neck and thoracic surgery. A consecutive sample of patients diagnosed with unilateral vocal fold immobility with patient- or clinician-identified abnormal swallow function who underwent bedside or in-office vocal fold injection was included in the study. Fiberoptic endoscopic evaluation of swallowing, Eating Assessment Tool-10 scores, Functional Oral Intake Scale scores, and patient perceptual assessment of swallow were evaluated pre- and postinjection. Twenty-one patients with new-onset unilateral vocal fold immobility who underwent injection laryngoplasty were evaluated. Median Eating Assessment Tool-10 and Functional Oral Intake Scale scores postinjection were significantly improved from preinjection. Patients who initially required restricted oral diets, or were nil per os, were able to advance their diet after injection laryngoplasty. Injection laryngoplasty is a safe and effective intervention for improvement of dysphagia in patients with unilateral vocal fold immobility. A single treatment may markedly reduce or eliminate risk of aspiration and potential sequelae.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

2018

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“…Previous studies reporting on dysphagia prevalence in patients with UVP report a wide range of results (20%–72%) . This wide range of estimated dysphagia prevalence reflects varied study methodologies, particularly with regard to the definition of dysphagia used to characterize those with UVP and dysphagia.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis

et al. 2019

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Objectives/Hypothesis The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. Study Design Retrospective medical chart review. Methods Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. Results A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. Conclusion Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. Level of Evidence IV Laryngoscope, 130:2397–2404, 2020

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“…Diminished pharyngeal contractile function resulting in inadequate pharyngeal clearance is common after neurological injury, radiation therapy for head and neck malignancy, oncologic surgery, as well as in advanced age and contributes to significant swallow impairment leading to aspiration, aspiration pneumonia, and malnutrition (2,9,11,14,15,20,25,26,28,(32)(33)(34).…”

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confidence: 99%

Effects of laryngeal restriction on pharyngeal peristalsis and biomechanics: Clinical implications

Shaker

Sanvanson

Balasubramanian

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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To date, rehabilitative exercises aimed at strengthening the pharyngeal muscles have not been developed due to the inability to successfully overload and fatigue these muscles during their contraction, a necessary requirement for strength training. The purpose of this study was to test the hypothesis that applying resistance against anterosuperior movement of the hyolaryngeal complex will overload the pharyngeal muscles and by repetitive swallowing will result in their fatigue manifested by a reduction in pharyngeal peristaltic amplitude. Studies were done in two groups. In group 1 studies 15 healthy subjects (age: 42 ± 14 yr, 11 females) were studied to determine whether imposing resistance to swallowing using a handmade device can affect the swallow-induced hyolaryngeal excursion and related upper esophageal sphincter (UES) opening. In group 2, an additional 15 healthy subjects (age 56 ± 25 yr, 7 females) were studied to determine whether imposing resistance to the anterosuperior excursion of the hyolaryngeal complex induces fatigue manifested as reduction in pharyngeal contractile pressure during repeated swallowing. Analysis of the video recordings showed significant decrease in maximum deglutitive superior laryngeal excursion and UES opening diameter ( P < 0.01) due to resistive load. Consecutive swallows against the resistive load showed significant decrease in pharyngeal contractile integral (PhCI) values ( P < 0.01). Correlation analysis showed a significant negative correlation between PhCI and successive swallows, suggesting “fatigue” ( P < 0.001). In conclusion, repeated swallows against a resistive load induced by restricting the anterosuperior excursion of the larynx safely induces fatigue in pharyngeal peristalsis and thus has the potential to strengthen the pharyngeal contractile function.

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

Abstract: Individuals with UVFI of iatrogenic and idiopathic etiologies with subjective dysphagia demonstrate objective evidence of pharyngeal weakness. The increased prevalence of aspiration in this population may not be solely the result of impaired airway protection.

Cited by 37 publications

References 8 publications

Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis

Effects of laryngeal restriction on pharyngeal peristalsis and biomechanics: Clinical implications

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