Chronic aspiration and laryngeal competence

Abstract

Aspiration into the lower respiratory tract can be detrimental to life. Ten patients, suffering from neurological dysphagia with aspiration, were studied. Neurological disorders can cause inadequate glottic closure resulting in aspiration. It has not been well recognized however, that even patients who have full glottic closure are still capable of aspirating in the pre- and post-deglutition stages of swallowing. The combined techniques of videofibrolaryngoscopy and videofluoroscopy are found to be the best methods for demonstrating these abnoralities. Development of new techniques, in the prevention of aspiration, should also take into account silent, pre- and post-deglutitional aspiration.

Relative contribution of various airway protective mechanisms to prevention of aspiration during swallowing

“…Aspiration during swallowing has been divided into three phases (1). Predeglutitive aspiration has been defined as entry of bolus into the airway before activation of the oral/pharyngeal phase of swallowing.…”

“…Intradeglutitive aspiration is the entry of swallowed bolus into the airway during the pharyngeal phase of swallowing while the bolus is traversing the pharynx. Postdeglutitive aspiration involves the entry of the swallowed bolus after completion of the act of swallowing by inhalation of residue left behind in the pharynx as a result of incomplete bolus clearance (1).…”

“…Videofluoroscopic and endoscopic studies of the temporal relationship between aspiration of swallowed material and the pharyngeal phase of swallowing have identified three periods: pre-, intra-, and postdeglutitive aspiration (1). The role of the mechanisms of deglutitive airway protection described above in prevention of aspiration during these three periods has not been systematically studied.…”

Radiographic evaluation of complex dysphagic patients: Comparison with videoendoscopic technique

“…Because of the cumulative radiation exposure and the difficulty in moving some patients to the radiology suite, the videoendoscopic swallow study (VESS) has been developed as part of the evaluation of oropharyngeal dysphagia [15][16][17][18][19][20]. In this technique, a small-diameter endoscope, such as a laryngoscope, bronchoscope, or a newer gastrointestinal endoscope, is inserted through the patient's nose and positioned at the level of the posterior nares.…”

Values and Limitations of Pharyngolaryngoscopy (Transnasal, Transoral) in Patients with Dysphagia

“…These structures are commonly observed during respiration, in nonspeech movements such as breath holding and coughing, during phonation and speech, as well as during swallowing (fiberoptic endoscopic evaluation of swallowing) [7][8][9]. Aviv et al [10] have recently described a method with a specifically designed fiberendoscope to deliver an air puff to the pharyngeal and laryngeal mucosa for sensory testing (fiberoptic endoscopic evaluation of swallowing with sensory testing).…”