Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity

Marian, Thomas; Schröder, Jens Burchard; Muhle, Paul; Claus, Inga; Riecker, Axel; Warnecke, Tobias; Suntrup‐Krueger, Sonja; Dziewas, Rainer

doi:10.1159/000479483

Cited by 23 publications

(23 citation statements)

References 51 publications

(62 reference statements)

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“…As globus is often treated as reflux disease or a somatoform disorder, further evidence linking sensory loss and globus sensation may change globus management . Also, a patient's risk of dysphagia and aspiration may be directly related to the degree of laryngeal sensory loss, as observed in these cases and previously studied in larger cohorts . Testing laryngeal sensation may be useful to predict risk of aspiration pneumonia, although more evidence is needed to definitively support this.…”

Section: Discussionmentioning

confidence: 81%

“…26 Also, a patient's risk of dysphagia and aspiration may be directly related to the degree of laryngeal sensory loss, as observed in these cases and previously studied in larger cohorts. 11,[27][28][29] Testing laryngeal sensation may be useful to predict risk of aspiration pneumonia, 10,29,30 although more evidence is needed to definitively support this.…”

Section: Discussionmentioning

confidence: 99%

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Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Santoso

Paydarfar

2019

Head & Neck

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Background Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed “sensory dysphagia” and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. Methods and Results Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation. Conclusions Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Santoso

Paydarfar

2019

Head & Neck

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“…In geriatric patients, a reduction of myelinated fibers of the superior laryngeal nerve leads to sensory impairment in the pharyngeal and supraglottic areas [38][39][40], together with other contributors resulting in age-related swallowing dysfunction called presbyphagia [41]. In patients suffering from post-stroke dysphagia, a negative correlation between penetration/tracheal aspiration and laryngeal sensitivity was described in two further studies using FEES [42,43]. New treatment approaches are of particular need in these patients who suffer from severe dysphagia and who are often immobilized and need to be monitored.…”

Section: Applicability and Justification Of The Proposed Lesion Modelmentioning

confidence: 99%

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

et al. 2018

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Background/Aims: Performing neurophysiological and functional imaging studies in severely affected patients to investigate novel neurostimulation techniques for the treatment of neurogenic dysphagia is difficult. Therefore, basic research needs to be conducted in healthy subjects. Swallowing is a motor function highly dependent on sensory afferent input. Here we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known as a major contributor to dysphagia in neurological disease. Methods: In this randomized crossover study on 11 healthy volunteers, cortical activation during pneumatic pharyngeal stimulation was measured applying magnetoencephalography in two separate sessions, with and without pharyngeal surface anesthesia. Results: Stimulation evoked bilateral event-related desynchronization (ERD) mainly in the caudolateral pericentral cortex. In comparison to the no-anesthesia condition, topical anesthesia led to a reduction of ERD in beta (13-30 Hz) and low gamma (30-60 Hz) frequency ranges (p<0.05) in sensory but also motor cortical areas. Conclusions: Withdrawal of sensory afferent information by topical anesthesia leads to reduced response to pneumatic pharyngeal stimulation in a distributed cortical sensorimotor network in healthy subjects. The proposed paradigm may serve to investigate the effect of neuromodulatory treatments specifically on pharyngeal sensory impairment as relevant cause of neurogenic dysphagia.

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“…Therefore, there is a huge spectrum of different diseases in which impaired sensory feedback or its central processing contributes to dysphagia. In post stroke dysphagia, laryngeal hypesthesia is associated with altered motor activity and aspiration . In Parkinson's disease sensory, pharyngeal nerves are directly affected by the Lewy pathology, which is associated with dysphagia .…”

Section: Introductionmentioning

confidence: 99%

“…In post stroke dysphagia, laryngeal hypesthesia is associated with altered motor activity and aspiration. 21,22 In Parkinson's disease sensory, pharyngeal nerves are directly affected by the Lewy pathology, which is associated with dysphagia. 23 In geriatric patients with dysphagia, age-related reduced pharyngeal sensation 24 is an important contributing factor.…”

Section: Introductionmentioning

confidence: 99%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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Background Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. Methods A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue‐dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. Key Results The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = −3.82; P = .001), 0.3 mL (t = −4.65; P < .000), 0.4 mL (t = −5.77; P < .000), and 0.5 mL (t = −3.49; P = .005). Conclusion and Inferences Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.

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Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity

Cited by 23 publications

References 51 publications

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

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