Swallowing performance in patients with vocal fold motion impairment

Abstract

Twenty-seven patients with vocal fold motion impairment underwent detailed pharyngoesophagel manometry with a strain gauge assembly linked to a computer recorder. Nine were known to have lesions of the central vagal trunk or nucleus, 9 had recurrent laryngeal nerve (RLN) palsy, and the remainder were idiopathic. The site of the lesion was a more important determinant of subjective swallowing performance than the position of the involved cord at laryngoscopy. Patients with central lesions had lower tonic and contraction upper esophageal sphincter (UES) pressures than 25 age-matched controls, suggesting that high cervical branches of the lower cranial nerves are important in UES excitatory innervation. RLN palsy patients showed significantly increased pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations. The results suggest that the dysphagia associated with vocal fold motion impairment is not simply due to the disruption of laryngeal deglutitive kinetics, but to independent effects on pharyngeal function.

Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

“…These situations, inadequate pharyngeal pressure, decrease in the subglottic air pressure, and longer pharyngeal contraction duration, should be the explanation for the longer UES transit for patients with pharyngeal innervation impairment and patients without clear innervation impairment. Patients whose vocal fold immobility is of idiopathic etiology have similar alterations in pharynx and UES to those shown by patients with recurrent pharyngeal nerve impairment [7]. The slower UES transit, and consequent longer UES opening duration, may cause dysphagia and increase the number of subjects with pharyngeal residues.…”

“…Some patients with vocal fold immobility had abnormal pharyngeal stripping wave and pharyngeal retention [13], but UES opening impairment was not found in these patients [1,13]. The longer UES transit should be the consequence of the impossibility of the pharynx to generate enough pressure [13], longer pharyngeal contraction duration [7], and a decrease in the subglottic air pressure [14]. Positive subglottic pressure during swallowing is required for an efficient swallow.…”

“…Abnormalities of supraglottic laryngeal and pharyngeal functions were found in patients with recurrent laryngeal nerve injury and ipsilateral vocal fold immobility [6,7]. An increase in pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations were reported in patients with vocal fold motion impairment [7].…”

“…Abnormalities of supraglottic laryngeal and pharyngeal functions were found in patients with recurrent laryngeal nerve injury and ipsilateral vocal fold immobility [6,7]. An increase in pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations were reported in patients with vocal fold motion impairment [7]. If the paresis of the recurrent laryngeal nerve is associated with paresis of the superior laryngeal nerve, there is impairment of the pharyngeal constrictor musculature [6].…”

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

“…The diagnosis of isolated Xth nerve paralysis (XNP) following trauma, skull base infections, jugular foramen abnormalities, and tumors requires appropriate examinations [2]. Because swallowing dysfunction is more severe in XNP due to the impairment of the pharynx, laryngeal sensation, and upper esophageal sphincter [1,3,4] compared to isolated recurrent laryngeal nerve paralysis (RLNP), a videoendoscopic swallowing study (VESS) is useful for assessing pharyngeal function in XNP [5,6]. However, it is difficult to quantify pharyngeal function, particularly the pharyngeal residue, with VESS.…”