Relationship Between Laryngeal Sensory Deficits, Aspiration, and Pneumonia in Patients with Dysphagia

Abstract

The laryngeal adductor reflex (LAR) is an airway protective reflex that manifests as a brief vocal fold closure in response to laryngeal stimulation. This study examined if the absence of the LAR in response to touch delivered by a laryngoscope is associated with penetration/aspiration or pneumonia in patients with dysphagia. Inpatients at a teaching hospital with clinical symptoms of dysphagia were recruited upon referral to the otolaryngology clinic for a swallowing evaluation. Otolaryngologists observed the status of secretions and touched each arytenoid with the tip of the laryngoscope. The patients were then asked to swallow 3-5 mL grape gelatin and 3-5 mL colored water. All procedures were video-recorded. Two independent raters noted absence/presence of the LAR and penetration/aspiration of pharyngeal secretions, gelatin, and water on the recorded videos. A diagnosis of pneumonia during the patient's entire hospital stay was determined by a review of the hospital's medical records. Statistical analyses were performed using Fisher's exact test. Sixty-one patients were included. Twenty-one patients (34.5%) did not exhibit the LAR. No association was found between the absent LAR and penetration or aspiration. There was, however, a significant association between an absence of the LAR and pneumonia development. Patients with an absent LAR had 6.8 times the odds of developing pneumonia as compared to those with a present LAR (OR 6.75; 95% CI 1.76-25.96; p < 0.01). Using the LAR as a marker of laryngeal sensory function appears to be valuable for identifying patients at high risk of pneumonia.

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

“…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.…”

“…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.…”

Involvement of the epithelial sodium channel in initiation of mechanically evoked swallows in anaesthetized rats

“…; Kaneoka et al . ). In the future, swallowing function evaluation that includes laryngeal sensitivity assessment may be useful for these patients.…”

Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care: A Systematic Review*

“…It is wellrecognized that intubation duration more than 2 days places patients at high risk for both acute and chronic dysphagia 25,34,41,53,54 that may result in aspiration, possibly leading to aspiration pneumonia or pneumonitis. [55][56][57][58][59] There are several potential contributing etiologies that might increase aspiration risk in this population, including compromised cognition, 60 sensory impairment, 17,61 reduced laryngeal adductor reflex, 62,63 and reduced strength in muscles involved in swallowing. 64 Emerging evidence is linking morphological laryngeal injury to aspiration, 41 with an aspiration prevalence of 38%−44% during oral consumption in patients with unilateral vocal fold immobility.…”