Air Pulse Quantification of Supraglottic and Pharyngeal Sensation: A New Technique

Aviv, Jonathan E.; Martin, John H.; Keen, Monte S.; Debell, M.; Blitzer, Andrew

doi:10.1177/000348949310201007

Cited by 156 publications

(128 citation statements)

References 9 publications

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“…It has been reported that long-term tracheotomy results in diminished and eventual loss of abductor (posterior cricoarytenoid muscle) activity [22] and a weakened, poorly coordinated laryngeal closure (thyroarytenoid muscle) response [35]. The laryngeal closure reflex in different populations, including patients with tracheotomy and ventilator dependency, needs to be investigated with the FEES with a sensory testing technique [36].…”

Section: Discussionmentioning

confidence: 99%

Effect of a One-Way Tracheotomy Speaking Valve on the Incidence of Aspiration in Previously Aspirating Patients with Tracheotomy

Leder

1999

Dysphagia

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The purpose of the present study was to investigate the incidence of aspiration in previously aspirating patients with tracheotomy after use of a one-way tracheotomy tube speaking valve. Twenty consecutive inpatients from the acute care setting of a large urban tertiary care teaching hospital were included. All subjects had objective documentation of aspiration by a fiberoptic endoscopic evaluation of swallowing prior to placement of a one-way tracheotomy speaking valve, from 2 to 7 days of valve use with intelligible speech production, and no surgery to the upper aerodigestive tract except tracheotomy. Results indicated that incidence of aspiration was not affected by use of a one-way tracheotomy speaking valve. These results are in agreement with previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status. Also, no significant differences were found between aspiration status and time since tracheotomy, time off ventilator, or duration of valve use. It was concluded that use of a one-way speaking valve provided mostly nondeglutitive benefits and should not be considered to promote successful swallowing for patients with tracheotomy in the acute care setting.

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Section: Discussionmentioning

confidence: 99%

Effect of a One-Way Tracheotomy Speaking Valve on the Incidence of Aspiration in Previously Aspirating Patients with Tracheotomy

Leder

1999

Dysphagia

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“…This is at odds with the well-documented observations that the majority of swallow-related measures among older people reveal slower and less ecient swallowing [2,31±33]. These include increased stagetransition duration, pharyngeal transit duration, duration to UES opening, and total swallowing duration [2,31,33]; and higher sensory thresholds in the pyriform sinus [32]. The reasons for our unexpected ®nding are not clear; however, it may be related to the relative good health and younger age of our subjects compared with those of previous studies (®ve of the seven were under the age of 70).…”

Section: Age and Gender Findingsmentioning

confidence: 99%

Effects of Mechanical, Cold, Gustatory, and Combined Stimulation to the Human Anterior Faucial Pillars

et al. 2003

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Tactile-Thermal Application (TTA) is a therapy technique designed to enhance the swallowing response in persons with dysphagia. In this study, TTA was broken down into each component stimulus (i.e., Cold, Mechanical, Gustatory), and all combinations thereof, to study the effects of each condition on measurable parameters of the normal human swallow response. Using surface electromyography (EMG), latency to swallow-specific activity and duration of submental EMG activity were measured to examine the following questions: (1) Are there stimulus-dependent differences in onset latencies and contraction durations of the submental muscle activity? (2) Which stimulus components are responsible for this response? (3) How long do the effects of stimulation last on the response? (4) Are there response differences according to age and gender? Between-subjects multivariate analysis of variance showed that the main effects for Treatment, Gender, and Age were significant. Latency to swallow-specific activity was significantly shorter following Mechanical + Cold + Gustatory condition compared to No Stimulation. The effect of stimulation on the swallow response lasted for only one swallow.

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“…Each method used air pulse stimulation of pyriform mucosa and aryepiglottic folds (the region innervated by the superior laryngeal nerve [SLN]). One method, psychophysical testing, has been described previously [12,17,18]. The second method, also previously described [13], was to elicit the laryngeal adductor reflex (LAR) as a measure of determining LP sensory thresholds.…”

Section: Feesst Protocolmentioning

confidence: 99%

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) in Healthy Controls

et al. 1998

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The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.

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Air Pulse Quantification of Supraglottic and Pharyngeal Sensation: A New Technique

Cited by 156 publications

References 9 publications

Effect of a One-Way Tracheotomy Speaking Valve on the Incidence of Aspiration in Previously Aspirating Patients with Tracheotomy

Effect of a One-Way Tracheotomy Speaking Valve on the Incidence of Aspiration in Previously Aspirating Patients with Tracheotomy

Effects of Mechanical, Cold, Gustatory, and Combined Stimulation to the Human Anterior Faucial Pillars

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) in Healthy Controls

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