Flexible endoscopic evaluation of swallowing with sensory testing in patients with unilateral vocal fold immobility: incidence and pathophysiology of aspiration.
OBJECTIVE
The objective was to examine the incidence and pathophysiology of aspiration in patients with unilateral vocal fold immobility presenting with dysphagia.


METHODS
Retrospective review of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) data and medical records in two tertiary medical care centers.


METHODS
The data for all patients with unilateral vocal fold immobility who underwent FEESST between 2000 and 2003 were reviewed.


RESULTS
Eighty-one patients (45 male and 36 female patients) were included in the study. The mean age was 59 years. The most common causes or origins were iatrogenic (42%), malignancy (23%), and neurological (18%). The immobility was left-sided in 59% of patients. A majority of the patients exhibited laryngeal edema/erythema (90%), difficulty with secretions (60%), and decreased laryngopharyngeal sensation (83%). The laryngeal adductor reflex was absent in 34% of the patients. An aspiration rate of 35% was detected with thin liquids. Trials of purees revealed a 76% rate of pooling, 44% rate of spillage, 32% rate of penetration, 18% rate of aspiration, and 24% rate of regurgitation. Rates of penetration and aspiration with purees were significantly higher in patients who had decreased laryngopharyngeal sensation, absent pharyngeal squeeze, and absent laryngeal adductor reflex.


CONCLUSIONS
Dysphagia in patients with unilateral vocal fold immobility is demonstrated during FEESST by pooling, spillage, penetration, and aspiration. The pathophysiology of dysphagia is multifactorial with decreased sensation and limitation of airway protective mechanisms both acting as contributing factors.
Tabaee
Abtin
A
Department of Otorhinolaryngology-Head and Neck Surgery, New York Presbyterian Hospitals, Weill Medical College of Cornell University, New York, New York 10021, USA.
Murry
Thomas
T
Zschommler
Anne
A
Desloge
Rosemary B
RB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology*; D004487:Edema / Q000503:physiopathology; D004890:Erythema / Q000503:physiopathology; D005260:Female; D005683:Gagging / Q000502:physiology; D006801:Humans; D001239:Inhalation; D007818:Laryngeal Diseases / Q000503:physiopathology; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000502:physiology; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology*; D012678:Sensation Disorders / Q000150:complications; D014826:Vocal Cord Paralysis / Q000150:complications / Q000503:physiopathology*