The Association between Laryngopharyngeal Sensory Deficits, Pharyngeal Motor Function, and the Prevalence of Aspiration with Thin Liquids

Setzen, Michael; Cohen, Manderly; Perlman, Philip W.; Belafsky, Peter C.; Guss, Joel; Mattucci, Kenneth F.; Ditkoff, Michael

doi:10.1067/mhn.2003.52

Cited by 72 publications

(66 citation statements)

References 11 publications

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“…Lastly, by definition, patients with motor neuron disease are without sensory deficits. Therefore, endoscopic sensory assessment of the laryngopharynx, although reported to be predictive of airway protection without administration of a food bolus [15], may not be optimal for the evaluation of swallowing in the ALS population.…”

Section: Discussionmentioning

confidence: 95%

Use of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Amyotrophic Lateral Sclerosis

2004

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This study investigated the use of fiberoptic endoscopic evaluation of swallowing (FEES) to both diagnose pharyngeal dysphagia and make treatment recommendations in 17 consecutive patients with a new diagnosis of amyotrophic lateral sclerosis (ALS) and complaints of dysphagia. Ten of 17 (59%) patients exhibited pharyngeal dysphagia with aspiration or aspiration risk with clear liquids, i.e., 5 of 8 (63%) limb and 5 of 9 (56%) bulbar. If depth of bolus flow was a problem, thickened liquids and single, small bolus sizes were recommended. If bolus retention was a problem, a small clear liquid bolus after each puree or solid bolus was recommended to aid pharyngeal clearing. Five of 17 (30%) patients required multiple FEES evaluations because of disease progression. For the first time in patients with ALS, FEES was shown to be successful in assessing preswallow anatomy and physiology, diagnosing pharyngeal dysphagia, and providing objective data for appropriate therapeutic interventions to promote safer oral intake. Visual biofeedback provided by FEES was successful for both patient and family education and to investigate individualized therapeutic strategies that, if successful, can be implemented immediately. Serial FEES allows for objective monitoring of dysphagia symptoms and timely implementation of diet changes and/or therapeutic strategies to continue safer oral intake and maintain optimum quality of life.

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Section: Discussionmentioning

confidence: 95%

Use of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Amyotrophic Lateral Sclerosis

2004

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“…Furthermore, several clinical studies confirmed the impact of sensory feedback by using oropharyngeal anesthesia [2,5,15,16]. A study using flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagic patients showed that severe laryngopharyngeal sensory deficits resulted in aspiration of liquids regardless of the pharyngeal motor function [36]. This points to the outstanding role of sensory input in swallowing.…”

Section: Discussionmentioning

confidence: 99%

Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing

et al. 2007

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BackgroundSensory input is crucial to the initiation and modulation of swallowing. From a clinical point of view, oropharyngeal sensory deficits have been shown to be an important cause of dysphagia and aspiration in stroke patients. In the present study we therefore investigated effects of functional oropharyngeal disruption on the cortical control of swallowing. We employed whole-head MEG to study cortical activity during self-paced volitional swallowing with and without topical oropharyngeal anesthesia in ten healthy subjects. A simple swallowing screening-test confirmed that anesthesia caused swallowing difficulties with decreased swallowing speed and reduced volume per swallow in all subjects investigated. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of the individual SAM data was performed using a permutation test.ResultsThe analysis of normal swallowing revealed bilateral activation of the mid-lateral primary sensorimotor cortex. Oropharyngeal anesthesia led to a pronounced decrease of both sensory and motor activation.ConclusionOur results suggest that a short-term decrease in oropharyngeal sensory input impedes the cortical control of swallowing. Apart from diminished sensory activity, a reduced activation of the primary motor cortex was found. These findings facilitate our understanding of the pathophysiology of dysphagia.

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“…Sensory deficits generally compound the effects of motor deficits associated with RLN injury. Indeed, the most severe forms of swallowing impairment are classically associated with combined injuries to both the RLN and the superior laryngeal nerve (SLN), because of additional loss of laryngeal sensory input with SLN damage [17,21,22]. This appears to have been the case with Patient No.…”

Section: Discussionmentioning

confidence: 94%

Analysis of Respiratory Complications After Minimally Invasive Esophagectomy: Preliminary Observation of Persistent Aspiration Risk

2006

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Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.

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The Association between Laryngopharyngeal Sensory Deficits, Pharyngeal Motor Function, and the Prevalence of Aspiration with Thin Liquids

Cited by 72 publications

References 11 publications

Use of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Amyotrophic Lateral Sclerosis

Use of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Amyotrophic Lateral Sclerosis

Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing

Analysis of Respiratory Complications After Minimally Invasive Esophagectomy: Preliminary Observation of Persistent Aspiration Risk

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