A Comparison of 2 Methods of Endoscopic Laryngeal Sensory Testing

Kaneoka, Asako; Krisciunas, Gintas P.; Walsh, Kayo; Raade, Adele S.; Langmore, Susan E.

doi:10.1177/0003489414550241

Cited by 34 publications

(46 citation statements)

References 22 publications

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“…In another study with patients after radiotherapy of head and neck tumors, this association could not be confirmed . One explanation for the discrepant findings may be a low inter‐observer agreement, which is likely due to the difficulty in establishing a standard distance to the pharynx from the tip of the endoscope . In our study, we tried to avoid a similar problem by using quantifiable liquid volumes.…”

Section: Discussionmentioning

confidence: 75%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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Background Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. Methods A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue‐dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. Key Results The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = −3.82; P = .001), 0.3 mL (t = −4.65; P < .000), 0.4 mL (t = −5.77; P < .000), and 0.5 mL (t = −3.49; P = .005). Conclusion and Inferences Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.

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Section: Discussionmentioning

confidence: 75%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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“…FEESST involves observation of an objective marker of laryngeal sensation by eliciting the laryngeal adductor reflex (LAR), or a brief protective closure of the vocal cords, by delivering air pulses to the mucosa . Langmore has compared this method to eliciting the LAR by touching the arytenoids with the laryngoscope . While laryngeal sensory testing has been shown to be safe and potentially equal to MBS in anticipating pneumonia, it has not yet been broadly adopted .…”

Section: Discussionmentioning

confidence: 99%

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Santoso

Paydarfar

2019

Head & Neck

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Background Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed “sensory dysphagia” and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. Methods and Results Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation. Conclusions Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.

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“…This sequential motor activity of muscles is modulated by sensory feedback and sensory input plays essential part in pharyngeal swallow . It has been demonstrated that the application of sensory stimulation in oropharyngeal area modulates swallowing performance and involves facilitation of swallowing initiation Sensory impairments in pharyngeal area are associated with penetration or aspiration in dysphagic patients, and oropharyngeal anesthesia results in disruption of swallowing movement even in healthy humans . Furthermore, impaired pharyngeal sensitivity is associated with reduced cortical activation …”

Section: Introductionmentioning

confidence: 99%

Cold thermal oral stimulation produces immediate excitability in human pharyngeal motor cortex

Magara

Watanabe

Tsujimura

et al. 2018

Neurogastroenterology Motil

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A Comparison of 2 Methods of Endoscopic Laryngeal Sensory Testing

Abstract: Sensory impairment detected by the air pulse method does not appear to be associated with risk of penetration/aspiration. Significant laryngeal sensory loss revealed by the touch method is associated with compromised airway protection.

Cited by 34 publications

References 22 publications

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Cold thermal oral stimulation produces immediate excitability in human pharyngeal motor cortex

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