Laryngeal Adductor Reflex and Pharyngeal Squeeze as Predictors of Laryngeal Penetration and Aspiration

• Published in: The Laryngoscope 2002-02, Vol.112 (2), p.338-341
• Main Authors: Aviv, Jonathan E., Spitzer, Jaclyn, Cohen, Manderly, Ma, Guoguang, Belafsky, Peter, Close, Lanny G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; aspiration; Biological and medical sciences; Deglutition - physiology; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Dysphagia; endoscopy; Female; Humans; Inhalation - physiology; Laryngeal Muscles - innervation; Laryngeal Muscles - physiopathology; Laryngoscopy - methods; larynx; Male; Medical sciences; Middle Aged; Muscle Contraction - physiology; Non tumoral diseases; Otorhinolaryngology. Stomatology; Pneumology; Predictive Value of Tests; Probability; Prospective Studies; Reference Values; Reflex, Abnormal - physiology; Respiratory system : syndromes and miscellaneous diseases; Risk Assessment; sensation; Sensation Disorders - complications; Sensation Disorders - diagnosis; Sensitivity and Specificity; Sensory Thresholds; Severity of Illness Index; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200202000-00025

Objectives The contribution of laryngopharyngeal (LP) sensory deficits to the outcome of swallowing and the relationship between sensory and motor deficits in the laryngopharynx is unclear. The study purpose is to determine if patients with LP sensory and motor deficits are at increased risk for laryngeal penetration and aspiration during swallowing, and to determine the relationship between pharyngeal motor weakness and LP sensory deficits. Materials and Methods Endoscopic evaluation of swallowing with sensory testing was performed on 122 dysphagic patients who were prospectively divided into two groups. The control group was 76 patients with normal sensitivity, determined by an intact laryngeal adductor reflex (LAR) on air pulse stimulation of the mucosa innervated by the superior laryngeal nerve. The study group was 46 patients with severe sensory deficits, determined by an absent LAR. Each group was given puree followed by thin liquid, noting presence or absence of laryngeal penetration and aspiration. Pharyngeal muscle strength was assessed by noting presence or absence of pharyngeal contraction during voluntary adduction of the vocal folds (pharyngeal squeeze). Results In control subjects, with purees, 6 of 76 (7.90%) penetrated and 3 of 76 (3.94%) aspirated; with thins, 26 of 76 (34.2%) penetrated and 13 of 76 (17.1%) aspirated. In the absent LAR group, with purees, 39 of 46 (84.8%) penetrated and 32 and 46 (69.6%) aspirated; with thins, 46 of 46 (100%) penetrated and 43 of 46 (93.5%) aspirated. For both consistencies, the differences in prevalence of penetration and aspiration between groups was significant (P