Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

Aneas, Geruza Costa Gonzaga; Ricz, Hilton Marcos Alves; Mello-Filho, Francisco Veríssimo; Dantas, Roberto Oliveira

doi:10.2174/1874428101004010077

Cited by 5 publications

(10 citation statements)

References 18 publications

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“…As the RLN also provides innervation to the esophagus in addition to the intrinsic laryngeal muscles, the trend for increased esophageal transit time following RLN transection observed in this study is consistent with pharyngoesophageal dysfunction documented in other RLN injury models (Fukushima et al, 2005;Gould et al, 2015;Tsujimura et al, 2018) and human unilateral VF paralysis patients (Aneas, Ricz, Mello-Filho, & Dantas, 2010;Wilson, Pryde, White, Maher, & Maran, 1995). As such, future studies may benefit by utilizing a higher speed camera to better capture the start and end points of esophageal bolus transit or alternative methods, such as manometry, to accurately determine if significant pharyngeal or esophageal dysphagia exists in this small, fast-drinking species.…”

Section: Discussionsupporting

confidence: 88%

Recurrent laryngeal nerve transection in mice results in translational upper airway dysfunction

Haney

Hamad

Woldu

et al. 2019

J of Comparative Neurology

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The recurrent laryngeal nerve (RLN) is responsible for normal vocal‐fold (VF) movement, and is at risk for iatrogenic injury during anterior neck surgical procedures in human patients. Injury, resulting in VF paralysis, may contribute to subsequent swallowing, voice, and respiratory dysfunction. Unfortunately, treatment for RLN injury does little to restore physiologic function of the VFs. Thus, we sought to create a mouse model with translational functional outcomes to further investigate RLN regeneration and potential therapeutic interventions. To do so, we performed ventral neck surgery in 21 C57BL/6J male mice, divided into two groups: Unilateral RLN Transection (n = 11) and Sham Injury (n = 10). Mice underwent behavioral assays to determine upper airway function at multiple time points prior to and following surgery. Transoral endoscopy, videofluoroscopy, ultrasonic vocalizations, and whole‐body plethysmography were used to assess VF motion, swallow function, vocal function, and respiratory function, respectively. Affected outcome metrics, such as VF motion correlation, intervocalization interval, and peak inspiratory flow were identified to increase the translational potential of this model. Additionally, immunohistochemistry was used to investigate neuronal cell death in the nucleus ambiguus. Results revealed that RLN transection created ipsilateral VF paralysis that did not recover by 13 weeks postsurgery. Furthermore, there was evidence of significant vocal and respiratory dysfunction in the RLN transection group, but not the sham injury group. No significant differences in swallow function or neuronal cell death were found between the two groups. In conclusion, our mouse model of RLN injury provides several novel functional outcome measures to increase the translational potential of findings in preclinical animal studies. We will use this model and behavioral assays to assess various treatment options in future studies.

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Section: Discussionsupporting

confidence: 88%

Recurrent laryngeal nerve transection in mice results in translational upper airway dysfunction

Haney

Hamad

Woldu

et al. 2019

J of Comparative Neurology

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“…12 Moreover, 1 study reported that patients with UVFP exhibit an alteration of bolus transit through the upper esophageal sphincter and have no adaptation in swallowing timing related to the increase in bolus volume. 11 These studies verify the increased risk of dysphagia among patients with UVFP and provide possible mechanisms.…”

Section: Discussionmentioning

confidence: 58%

“…6,7 Based on the results of fiberoptic endoscopy and stroboscopy evaluation, previous studies reported that UVFP increases the odds of aspiration. [8][9][10][11][12][13] To the best of our knowledge, the long-term risk of pneumonia among patients with UVFP remains unknown. Therefore, this study investigated whether UVFP is a risk factor of pneumonia.…”

mentioning

confidence: 99%

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Tsai

Yang

Liu

et al. 2018

Otolaryngol.--head neck surg.

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Objective To investigate pneumonia risk among patients with unilateral vocal fold paralysis (UVFP). Study Design Retrospective population-based cohort study. Setting This study used data from the National Health Insurance Research Database of Taiwan, a nationwide population-based database. Subjects and Methods A total of 419 patients newly diagnosed with UVFP between January 1, 1997, and December 31, 2013, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients. Moreover, 1676 patients without UVFP were matched to patients with UVFP at a 1:4 ratio based on age, sex, socioeconomic status, urbanization level, and site-specific cancers. Patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of pneumonia. Results The cumulative incidence of pneumonia was significantly higher for patients with UVFP than those without UFVP ( P < .001). The adjusted Cox proportional hazard model showed that UVFP was significantly associated with a higher incidence of pneumonia (hazard ratio, 1.97; 95% CI, 1.35-2.86; P < .001). Subgroup analyses demonstrated that UVFP was an independent risk factor of pneumonia for 4 subgroups: young (18-50 years), older (≥51 years), male, and cancer. Conclusion This is the first nationwide population-based cohort study to investigate the association between UVFP and pneumonia. The findings indicate that UVFP is an independent risk factor of pneumonia. Given the study results, physicians should be aware of the potential for pneumonia occurrence following UVFP.

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“…2002, Aneas et al . 2010, Zhou et al . 2018) supports its application to swallowing assessment using US.…”

Section: Discussionmentioning

confidence: 99%

“…While there was homogeneity amongst laryngeal studies, in all but one (12/13)study outcome measures were limited to the assessment of vocal fold function in a surgical population. While this restricts the applicability of findings to SLT patients where more complex assessment of laryngeal function is required, the association of vocal fold palsy with glottal incompetence and aspiration (Bhattacharyya et al 2002, Aneas et al 2010, Zhou et al 2018 supports its application to swallowing assessment using US.…”

Section: Discussionmentioning

confidence: 99%

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

Allen

Clunie

Slinger

et al. 2020

Intl J Lang & Comm Disor

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Background: Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID-19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non-invasive, non-aerosol-generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature. Aim: To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults. Methods & Procedures: A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS-2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration. Outcomes & Results: Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peerreviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3-100% and 48.5-100%, respectively. Conclusions & Implications: There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a

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Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

Cited by 5 publications

References 18 publications

Recurrent laryngeal nerve transection in mice results in translational upper airway dysfunction

Recurrent laryngeal nerve transection in mice results in translational upper airway dysfunction

Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population‐Based Cohort Study

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

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