Laryngeal Paralysis: Distinguishing Xth Nerve from Recurrent Nerve Paralysis Through Videoendoscopic Swallowing Study (VESS)

Périé, Sophie; Roubeau, Bernard; Guily, Jean Lacau St

doi:10.1007/s00455-003-0025-7

Cited by 17 publications

(1 citation statement)

References 28 publications

(41 reference statements)

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“…Although it was reported that the pharyngeal branch of the vagus nerve plays a major role in elevating the larynx (5), the RLN also may be involved in this movement. Some clinical reports noted that isolated RLN paralysis rarely affects bolus residue or saliva pooling in the pyriform sinus just above the UES (12,24), so isolated RLN damage may have less influence on the pharyngeal function during swallowing.…”

Section: Discussionmentioning

confidence: 99%

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Tsujimura

Suzuki

Yoshihara

et al. 2018

Journal of Applied Physiology

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Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

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Section: Discussionmentioning

confidence: 99%

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Tsujimura

Suzuki

Yoshihara

et al. 2018

Journal of Applied Physiology

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

et al. 2019

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Objectives/Hypothesis The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. Study Design Retrospective medical chart review. Methods Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. Results A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. Conclusion Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. Level of Evidence IV Laryngoscope, 130:2397–2404, 2020

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Postdeglutitive residue in vagus nerve paralysis and its association with feeding style

Kumai

Samejima

Yumoto

2016

Eur Arch Otorhinolaryngol

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The objective of this study is to compare the postdeglutitive pharyngeal residues between Xth cranial nerve paralysis (XNP) and isolated recurrent laryngeal nerve paralysis (RLNP) to elucidate the association with feeding style. This study enrolled 15 XNP patients with injuries at the brainstem level (Group I) and 26 patients with RLNP (Group II). All subjects underwent videofluoroscopic swallowing studies (VFSS). The pyriform sinus (PS) and vallecula residues were quantified. The symmetry of the affected versus non-affected sides was compared in both groups. Feeding style at the time of VFSS was also examined. The intra-rater correlation coefficients for all of the data, including the areas of both the vallecula and pyriform sinus on the affected and non-affected sides, were 0.88-0.92 (p < 0.001), reflecting high consistency of the evaluation. In Group I, there was significantly (p < 0.01) more residue in the PS, but not vallecula, compared to the respective non-affected sides, while in Group II there were no significant differences in residue between the affected and non-affected sides for either the vallecula or PS. Comparing Groups I and II, there was significant (p < 0.01) residue on the affected side in the PS but not the vallecula. There was a significant correlation between dependency on a feeding tube and XNP (p < 0.01, Chi-square test). XNP at the brainstem level may cause significantly increased residue in the PS compared to RLNP. This might increase the dependency on a feeding tube with XNP.

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Laryngeal Paralysis: Distinguishing Xth Nerve from Recurrent Nerve Paralysis Through Videoendoscopic Swallowing Study (VESS)

Cited by 17 publications

References 28 publications

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

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

Postdeglutitive residue in vagus nerve paralysis and its association with feeding style

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