Vocal Fold Immobility and Aspiration Status: A Direct Replication Study

Abstract

The purpose of this direct replication study was to confirm the incidence of vocal fold immobility (VFI) and its relationship to pharyngeal dysphagia and aspiration. Using a single-group consecutively referred case series, a total of 2,650 participants underwent fiberoptic endoscopic evaluation of swallowing between August 2003 and December 2007. Main outcome measures included overall incidence of VFI and aspiration status, with specific emphasis on age, gender, etiology and pharyngeal phase bolus flow characteristics, and side of VFI (right, left, or bilateral). These data were compared to and then combined with the original study (n = 1,452) for a total of 4,102 participants. Results indicated that the incidence of VFI was 4.3% (112/2,650), i.e., 27% (31/112) unilateral right, 58% (65/112) unilateral left, and 14% (16/112) bilateral. Incidence of aspiration was 22% (580/2,650). Of those with VFI, 40% (45/112) aspirated, i.e., 42% (13/31) unilateral right, 37% (24/65) unilateral left, and 50% (8/16) bilateral. An individual with VFI had 2.50 times the odds of aspirating as someone without VFI (95% CI = 1.86-3.37). For liquid aspiration, the odds ratio (OR) = 2.41 (95% CI = 1.77-3.28), and for puree aspiration, OR = 2.08 (95% CI = 1.47-2.93). Left VFI occurred most frequently due to surgical trauma. Liquid was aspirated more often than a puree. Males exhibited VFI more often than females. Side of VFI and age were not factors that increased the incidence of aspiration significantly. It was confirmed that VFI is not an uncommon finding during dysphagia testing and, when present, increased the odds of aspiration compared to a population already being evaluated for dysphagia.

Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility

“…The percentage of aspiration in this study was also comparable to previous studies, which identified aspiration in approximately 33% to 42% of individuals with UVFI . It is important to note that the present study was performed in an outpatient tertiary care center and most of the previous work evaluating aspiration in patients with UVFI was performed in acute care settings.…”

“…If airway protection is ineffective, an individual may aspirate material into the lungs, which may result in respiratory infection and/or death due to aspiration pneumonia. Approximately 33% to 42% of individuals with UVFI have been identified to aspirate . Diminished airway protection is presumed to be the primary cause of swallowing dysfunction in patients with UVFI .…”

Vocal palsy increases the risk of lower respiratory tract infection in low‐risk, low‐morbidity patients undergoing thyroidectomy for benign disease: A big data analysis

“…There is a growing body of clinical observations which suggest that a long‐term link may exist between vocal palsy and aspiration and whilst our study does not prove causality, but our findings are consistent with what is known of the physiology of the larynx and in particular, over‐reliance of the human swallowing mechanism on fine neurological control and thus its particular susceptibility to neuromuscular dysfunction . The incidence of laryngeal nerve injury in patients undergoing oesophagectomy and thoracic aortic surgery is 20%‐40%, and in these patients, it is known that post‐operative vocal palsy significantly increases the risk of hospital‐acquired pneumonia and length of stay .…”

“…The primary function of the larynx is sphincteric protection of the airway against ingress of digestive tract contents, and the principal mechanism by which this is achieved is reflexive closure of the true vocal folds during swallowing . Vocal palsy impairs glottic closure, and this is known to lead to dysphagia and aspiration in 20%‐40% of the affected patients …”

“…There are a wide range of surgical procedures that place normally functioning laryngeal nerves at risk of injury, which in turn places the patient at risk of post‐operative dysphonia, dysphagia, and less commonly, airway compromise . Thyroidectomy is the commonest of these procedures (Figure ).…”