Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

Abstract

Objective To identify dysphagia prevalence and characteristics among patients with unilateral vocal fold immobility (UVFI) through a systematic review of current literature. Data Sources Embase, PubMed, ScienceDirect, Wiley Online Library. Review Methods Four electronic databases were reviewed according to the PRISMA criteria. Original English-language studies examining dysphagia among adult patients with UVFI met eligibility. Two researchers independently analyzed qualified articles. Results Of 227 studies discovered through the literature search, 17 satisfied eligibility criteria. The prevalence of symptomatic dysphagia ranged from 55.6% to 69.0%, and the aspiration rate was 20.0% to 50.0%. Self-reporting and clinical evaluation were used to identify symptomatic dysphagia, while videofluoroscopic swallowing study and functional endoscopic evaluation of swallowing evaluated aspiration. Left-sided UVFI predominated. The most common causes of UVFI were iatrogenic and idiopathic. Central lesions and acute-onset UVFI were each associated with more severe dysphagia. Patients were more likely to aspirate on liquids versus purées and pastes. Benefits of medialization thyroplasty and vocal cord injection were equivocal. Conclusion A significant portion of patients with UVFI present with dysphagia due to anatomic and physiologic disruptions during the swallow. Study population heterogeneity and small sample sizes in the reviewed studies may have compromised reliability, calling for large-scale studies with rigorous methodology. Future studies should not only strive to identify the mechanics of the disordered swallow but also explore patients’ quality of life and the effectiveness of current treatments for dysphagia with underlying UVFI.

Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis

“…The current study's operational definitions were developed to reflect variants of dysphagia studied in prior literature. Review of previous research on this topic identified a range of methods used to define the presence of dysphagia, including patient self‐report of symptoms, medical record documentation of signs and symptoms during clinical examination, administration of dysphagia questionnaires (e.g., DHI or EAT‐10), instrumental assessment (MBS/FEES), and PAS rates . Thus, this study's definitions included: Dysphagia symptoms were listed as the chief complaint for the clinic appointment.…”

“…Thus, this study's definitions included: Dysphagia symptoms were listed as the chief complaint for the clinic appointment. This definition only included patient‐reported symptoms An abnormal total score on a dysphagia self‐report questionnaire.…”

“…The presence of signs or symptoms of dysphagia was documented by the clinician during the evaluation. This definition included both patient‐reported symptoms and clinician‐observed signs Instrumental assessment of swallowing (i.e., FEES or MBS) was recommended and completed based on findings from the clinical evaluation …”

“…Previous studies reporting on dysphagia prevalence in patients with UVP report a wide range of results (20%–72%) . This wide range of estimated dysphagia prevalence reflects varied study methodologies, particularly with regard to the definition of dysphagia used to characterize those with UVP and dysphagia.…”

“…Individuals with unilateral vocal fold paralysis (UVP) are believed to be at increased risk for dysphagia based on the assumption that impaired laryngeal closure during swallowing will lead to aspiration . Epidemiologic research into the prevalence of dysphagia symptoms in patients with UVP has substantiated these concerns.…”