Reliability of a laryngo-pharyngeal esthesiometer and a method for measuring laryngo-pharyngeal mechano-sensitivity in a prospectively recruited cohort of patients

Abstract

There are not reliable methods for measuring laryngo-pharyngeal mechano-sensitivity (LPMS). We aimed to determine the reliability of a new method for measuring LPMS using a new laryngo-pharyngeal esthesiometer (LPEER) in a prospective cohort of dysphagic stroke and non-dysphagic patients. The patients underwent clinical and endoscopic evaluations of swallowing (FESSST). The LPMS assessments consisted of measurements by an expert and a novel rater of the laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold (GRT) using the LPEER. We assessed the Bland-Altman limits of agreement, the intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). For the inter-rater comparisons, we contrasted the expert and novel raters. A total of 1608 measurements were obtained from 34 dysphagic stroke patients and 33 non-dysphagic patients. The intra-rater ICCs for all reflex thresholds were >0.90. The inter-rater ICCs were 0.87 for the LART, 0.79 for the CRT and 0.70 for the GRT. The intra-rater SCCs for all reflex thresholds were above 0.88 (P < 0.0001). The inter-rater SCC were 0.80 for the LART, 0.79 for the CRT and 0.70 for the GRT (all P < 0.0001). The Bland-Altman plots revealed good agreement for the LART and CRT and moderate agreement for the GRT. The median normal value was 0.14 mN for the LART, 4.4 mN for the CRT and 11.9 mN for the GRT. The median thresholds values in patients with aspiration were LART: 1.31 mN; CRT: 32.9 mN and GRT: 32.9 mN (all P < 0.006 vs normal thresholds). The LPEER exhibited substantial to excellent intra- and inter-rater reliability.

Accuracy and reliability of the sensory test performed using the laryngopharyngeal endoscopic esthesiometer and rangefinder in patients with suspected obstructive sleep apnoea hypopnoea: protocol for a prospective double-blinded, randomised, exploratory study

“…The high reliability obtained for the laryngopharyngeal sensory test using the LPEER on patients with dysphagia 31–34 cannot be generalised to patients with OSA, because these patients may have different reliability indexes. Any condition increasing or decreasing between-subject variance would affect the intraclass correlation coefficient (ICC) (which is the ratio of the between-subject variance over the total observed variance) of a clinical test.…”

“…Recently, Giraldo-Cadavid et al developed the LPEER, a device with which it was possible to accurately measure the threshold of the laryngeal adductor, cough, and gag reflexes. 31–34 The initial study was conducted in patients with oropharyngeal dysphagia and high intra- and inter-rater reliability in these patients was found. 31 33 The laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER), if shown to be valid in OSA, could be very useful to quantify the laryngopharyngeal sensory alterations of these patients to better understand OSA pathophysiological mechanisms and evaluate new therapeutic interventions for this condition.…”

“…The LPEER 31–34 is a potential solution to the problem of the precise and accurate assessment of laryngopharyngeal sensitivity. This device had high reliability when used for the exploration of laryngopharyngeal reflexes in patients with dysphagia.…”

“…This device had high reliability when used for the exploration of laryngopharyngeal reflexes in patients with dysphagia. 31 Therefore, it could be a new tool for evaluating and monitoring laryngopharyngeal sensory impairment in patients with OSA. However, the validity of sensory tests performed with this device has not yet been evaluated in patients with OSA; therefore, it’s intra-rater and inter-rater reliability and accuracy in this population are unknown.…”

“…The purpose of this study is to determine the intra-rater and inter-rater reliability and accuracy of the measurement of mechanical laryngopharyngeal sensitivity in patients with OSA, using the LPEER developed by Giraldo-Cadavid and co-workers. 31–34 …”