Abnormal Laryngopharyngeal Sensation in Adductor Laryngeal Dystonia Compared to Healthy Controls

Abstract

Background/ObjectivesLaryngeal sensory abnormality has been implicated as a component of adductor laryngeal dystonia (AdLD). The study objective was to assess laryngopharyngeal sensation in AdLD utilizing a calibrated, tactile aesthesiometer to deliver differential stimuli to lateral pyriform sinus (LPS), aryepiglottic fold (AEF), and false vocal fold (FVF).MethodsPatients with known Botox‐responsive AdLD underwent sensory testing using a previously‐validated methodology involving calibrated tactile stimuli (6–0, 5–0, 4.5–0, 4–0 nylon monofilaments). Laryngeal adductor reflex (LAR) and participant‐rated perceptual strength of stimulI were evaluated. Responses were compared to normative controls (n = 33). Two‐samples, Mann–Whitney and Fisher exact tests compared mean strength ratings and LAR between AdLD and control groups. Mixed‐effects logistic regression and linear models assessed association of filament size, stimulus site, age, sex, and LD status on LAR and perceptual strength rating respectively.ResultsThirteen AdLD patients (nine women, mean age 60+/−15 years) completed testing. Average LAR response rates were higher amongst all filament sizes in AdLD versus controls at LPS (56.3% vs. 35.7%) and AEF (96.1% vs. 70.2%) with comparable rates at FVF (90.2% vs. 91.7%). AdLD had 3.3 times the odds of observed LAR compared to controls (p = 0.005), but differences in subjective detection of stimuli, perceptual strength ratings, and cough/gag rates were insignificant on multivariate modeling (p > 0.05).ConclusionsThis is the first study to objectively assess laryngopharyngeal sensation in AdLD. Findings demonstrated increased laryngopharyngeal sensation in AdLD compared to controls. The identification of increased laryngeal hypersensitivity in these patients may improve understanding of AdLD pathophysiology and identify future targets for intervention.Level of Evidence2 Laryngoscope, 133:2271–2278, 2023

Laryngeal Hyposensitivity in Obstructive Sleep Apnea

“…6 Finally, the relationship between reduced sensation leading to reduced upper airway muscle tone has been reported. 2 The recent validation and deployment of Cheung-Bearelly monofilament aesthesiometers to assess laryngopharyngeal sensation in adult control [7][8][9][10][11] and impaired 12 subjects afford an opportunity to deliver calibrated constant force stimuli at specific laryngopharyngeal subsites to advance understanding of laryngeal pathophysiology in OSA. This testing method provides a wider field of view compared with air-pulse stimulation, enabling fine grain temporal analysis of LAR vocal fold motion that extends beyond binary judgment of whether a stimulus-triggered LAR response is present or absent.…”