Laryngeal sensitivity evaluation and dysphagia
Hospital Sírio-Libanês experience
Keywords:
Larynx, Dysphagia, Deglutation disorders, Gastroesophageal reflux, Language and hearing sciences speechAbstract
CONTEXT: Laryngeal sensitivity is important in the coordination of swallowing coordination and avoidance of aspiration. OBJECTIVE: To briefly review the physiology of swallowing and report on our experience with laryngeal sensitivity evaluation among patients presenting dysphagia. TYPE OF STUDY: Prospective. SETTING: Endoscopy Department, Hospital SírioLibanês. METHODS: Clinical data, endoscopic findings from the larynx and the laryngeal sensitivity, as assessed via the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) protocol (using the Pentax AP4000 system), were prospectively studied. The chi-squared and Student t tests were used to compare differences, which were considered significant if p < or = 0.05. RESULTS: The study included 111 patients. A direct association was observed for hyperplasia and hyperemia of the posterior commissure region in relation to globus (p = 0.01) and regurgitation (p = 0.04). Hyperemia of the posterior commissure region had a direct association with sialorrhea (p = 0.03) and an inverse association with xerostomia (p = 0.03). There was a direct association between severe laryngeal sensitivity deficit and previous radiotherapy of the head and neck (p = 0.001). DISCUSSION: These data emphasize the association between proximal gastroesophageal reflux and chronic posterior laryngitis, and suggest that decreased laryngeal sensitivity could be a side effect of radiotherapy. CONCLUSIONS: Even considering that these results are preliminary, the endoscopic findings from laryngoscopy seem to be important in the diagnosis of proximal gastroesophageal reflux. Study of laryngeal sensitivity may have the potential for improving the knowledge and clinical management of dysphagia.
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References
Langmore SE. Laryngeal sensation: a touchy subject. Dys- phagia. 1998;13(2):93-4.
Sanders I, Mu L. Anatomy of the human internal superior laryngeal nerve. Anat Rec. 1998;252(4):646-56.
Aviv JE. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med. 1997;103(5A):74S-76S.
Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol. 1993;102(10):777-80.
Aviv JE, Kim T, Sacco RL, et al. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol. 1998;107(5 Pt 1): 378-87.
Link DT, Willging JP, Miller CK, Cotton RT, Rudolph CD. Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol. 2000;109(10 Pt 1):899-905
Carr MM, Nguyen A, Poje C, Pizzuto M, Nagy M, Brodsky L. Correlation of findings on direct laryngoscopy and bron- choscopy with presence of extraesophageal reflux disease. Laryngoscope. 2000;110(9):1560-2.
Aviv JE, Liu H, Parides M, Kaplan ST, Close LG. Laryn- gopharyngeal sensory deficits in patients with laryngopha- ryngeal reflux and dysphagia. Ann Otol Rhinol Laryngol. 2000;109(11):1000-6.
Aviv JE, Parides M, Fellowes J, Close LG. Endoscopic evalua- tion of swallowing as an alternative to 24-hour pH monitoring for diagnosis of extraesophageal reflux. Ann Otol Rhinol Laryngol Suppl. 2000;184:25-7.
Spiegel JR, Selber JC, Creed J. A functional diagnosis of dysphagia using videoendoscopy. Ear Nose Throat J. 1998;77(8):628-32.
Setzen M, Cohen MA, Mattucci KF, Perlman PW, Ditkoff MK. Laryngopharyngeal sensory deficits as a predictor of aspiration. Otolaryngol Head Neck Surg. 2001;124(6):622-4.
Aviv JE, Johnson LF. Flexible endoscopic evaluation of swal- lowing with sensory test (FEESST) to diagnose and manage patients with pharyngeal dysphagia. Pract Gastroenterol. 2000;24(4):52-8.
Aviv JE, Kim T, Thomson JE, Sunshine S, Kaplan S, Close LG. Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls. Dysphagia. 1998;13(2):87-92.
Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110(4):563-74.
Aviv JE, Martin JH, Sacco RL, et al. Supraglottic and pharyn- geal sensory abnormalities in stroke patients with dysphagia. Ann Otol Rhinol Laryngol. 1996;105(2):92-7.
Aviv JE, Sacco RL, Mohr JP, et al. Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration and pneumonia after stroke. Laryngoscope. 1997;107(9):1254-60.
Aviv JE, Sacco RL, Thomson J, et al. Silent laryngopharyngeal sensory deficits after stroke. Ann Otol Rhinol Laryngol. 1997;106(2):87-93.
