Advertisement

Dysphagia

, Volume 33, Issue 2, pp 192–199 | Cite as

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

  • Asako Kaneoka
  • Jessica M. Pisegna
  • Haruhi Inokuchi
  • Rumi Ueha
  • Takao Goto
  • Takaharu Nito
  • Cara E. Stepp
  • Michael P. LaValley
  • Nobuhiko Haga
  • Susan E. Langmore
Original Article

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.

Keywords

Laryngeal sensory deficits Dysphagia Deglutition Laryngeal adductor reflex Aspiration Pneumonia 

Notes

Acknowledgements

The authors thank Mr. Yasunori Kumono and Mr. Masato Takahashi for their support in technical issues.

Funding

No funding was received for this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Andreatta RD, Mann EA, Poletto CJ, Ludlow CL. Mucosal afferents mediate laryngeal adductor responses in the cat. J Appl Physiol. 2002;93(5):1622–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Dua K, Surapaneni SN, Kuribayashi S, Hafeezullah M, Shaker R. Protective role of aerodigestive reflexes against aspiration: study on subjects with impaired and preserved reflexes. Gastroenterology. 2011;140(7):1927–33.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shingai T, Shimada K. Reflex swallowing elicited by water and chemical substances applied in the oral cavity, pharynx, and larynx of the rabbit. Jpn J Physiol. 1976;26(5):455–69.CrossRefPubMedGoogle Scholar
  4. 4.
    Shock LA, Gallemore BC, Hinkel CJ, et al. Improving the utility of laryngeal adductor reflex testing: a translational tale of mice and men. Otolaryngol Head Neck Surg. 2015;153(1):94–101.CrossRefPubMedGoogle Scholar
  5. 5.
    Sun QJ, Chum JM, Bautista TG, Pilowsky PM, Berkowitz RG. Neuronal mechanisms underlying the laryngeal adductor reflex. Ann Otol Rhinol Laryngol. 2011;120(11):755–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Onofri SM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Sato S, Fujishima I, Setsu K, Katagiri N, Inao R, Mizuma M. Evaluation for dysphagia by testing laryngeal sensation with a flexible laryngoscope. Jpn J Dysphagia Rehabil. 2002;6(4):44–52.Google Scholar
  8. 8.
    Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11(2):99–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Donzelli J, Brady S, Wesling M, Craney M. Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow. Ann Otol Rhinol Laryngol. 2003;112(5):469–75.CrossRefPubMedGoogle Scholar
  10. 10.
    Warnecke T, Ritter MA, Kroger B, et al. Fiberoptic endoscopic dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis. 2009;28(3):283–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Langmore S, Kenneth S, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2(4):216–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Leow LP, Beckert L, Anderson T, Huckabee ML. Changes in chemosensitivity and mechanosensitivity in aging and parkinson’s disease. Dysphagia. 2012;27(1):106–14.CrossRefPubMedGoogle Scholar
  13. 13.
    Domer AS, Kuhn MA, Belafsky PC. Neurophysiology and clinical implications of the laryngeal adductor reflex. Curr Otorhinolaryngol Rep. 2013;1(3):178–82.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Clayton NA, Carnaby GD, Peters MJ, Ing AJ. Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol. 2014;16(6):615–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Kaneoka A, Pisegna JM, Krisciunas GP, Nito T, Stepp CE, LaValley MP, Langmore SE. Variability of the pressure measurements exerted by the tip of laryngoscope during laryngeal sensory testing: a clinical demonstration. AJSLP. 2017;26(3):729–36.PubMedGoogle Scholar
  16. 16.
    Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol. 1993;102(10):777–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The glasgow coma scale at 40 years: standing the test of time. Lancet Neurol. 2014;13(8):844–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Leder SB, Suiter DM, Duffey D, Judson BL. Vocal fold immobility and aspiration status: a direct replication study. Dysphagia. 2012;27(2):265–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Cichero JA, Steele C, Duivestein J, et al. The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Rep. 2013;1:280–91.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Aviv JE, Murry T, Zschommler A, Cohen M, Gartner C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations. Ann Otol Rhinol Laryngol. 2005;114(3):173–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Ku PK, Vlantis AC, Leung SF, et al. Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma. Laryngoscope. 2010;120(2):223–8.PubMedGoogle Scholar
  24. 24.
    Hammer GP, Tomazic PV, Vasicek S, et al. Carotid endarterectomy significantly improves postoperative laryngeal sensitivity. J Vasc Surg. 2016;64(5):1303–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Phua SY, McGarvey LP, Ngu MC, Ing AJ. Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity. Thorax. 2005;60(6):488–91.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Amin MR, Harris D, Cassel SG, Grimes E, Heiman-Patterson T. Sensory testing in the assessment of laryngeal sensation in patients with amyotrophic lateral sclerosis. Ann Otol Rhinol Laryngol. 2006;115(7):528–34.CrossRefPubMedGoogle Scholar
  27. 27.
    Hammer MJ, Murphy CA, Abrams TM. Airway somatosensory deficits and dysphagia in parkinson’s disease. J Parkinsons Dis. 2013;3(1):39–44.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002;17(4):298–307.CrossRefPubMedGoogle Scholar
  29. 29.
    Langmore SE, Terpenning MS, Schork A, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81.CrossRefPubMedGoogle Scholar
  30. 30.
    Mor A, Thomsen RW, Ulrichsen SP, Sorensen HT. Chronic heart failure and risk of hospitalization with pneumonia: a population-based study. Eur J Intern Med. 2013;24(4):349–53.CrossRefPubMedGoogle Scholar
  31. 31.
    Zhu J, Zhang X, Shi G, Yi K, Tan X. Atrial fibrillation is an independent risk factor for hospital-acquired pneumonia. PLoS ONE. 2015;10(7):e0131782.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Johnson PE, Belafsky PC, Postma GN. Topical nasal anesthesia and laryngopharyngeal sensory testing: a prospective, double-blind crossover study. Ann Otol Rhinol Laryngol. 2003;112(1):14–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Kamarunas EE, McCullough GH, Guidry TJ, Mennemeier M, Schluterman K. Effects of topical nasal anesthetic on fiberoptic endoscopic examination of swallowing with sensory testing (FEESST). Dysphagia. 2014;29(1):33–43.CrossRefPubMedGoogle Scholar
  34. 34.
    Butler SG, Stuart A, Case LD, Rees C, Vitolins M, Kritchevsky SB. Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2011;120(5):288–95.CrossRefPubMedGoogle Scholar
  35. 35.
    Baijens LW, Speyer R, Pilz W, Roodenburg N. FEES protocol derived estimates of sensitivity: aspiration in dysphagic patients. Dysphagia. 2014;29(5):583–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Centers for disease control and prevention/National Healthcare Safety Network (CDC/NHSN) [Internet]. CDC/NHSN surveillance definitions for specific types of infections (2014) http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf33. Accessed 29 Sept 2016

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Asako Kaneoka
    • 1
    • 2
  • Jessica M. Pisegna
    • 2
  • Haruhi Inokuchi
    • 1
  • Rumi Ueha
    • 3
  • Takao Goto
    • 3
  • Takaharu Nito
    • 3
  • Cara E. Stepp
    • 2
    • 4
  • Michael P. LaValley
    • 4
  • Nobuhiko Haga
    • 1
  • Susan E. Langmore
    • 2
    • 5
  1. 1.Rehabilitation CenterThe University of Tokyo HospitalTokyoJapan
  2. 2.Department of Speech, Language & Hearing SciencesBoston University Sargent CollegeBostonUSA
  3. 3.Department of Otolaryngology and Head and Neck SurgeryGraduate School of Medicine, The University of TokyoTokyoJapan
  4. 4.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  5. 5.Department of Otolaryngology-Head and Neck SurgeryBoston University Medical CenterBostonUSA

Personalised recommendations