Laryngopharyngeal abnormalities in hospitalized patients with dysphagia.
OBJECTIVE
To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES).


METHODS
Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video-recorded by a speech-language pathologist (SLP).


METHODS
Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings.


RESULTS
Sixty-one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy-six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty-five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated.


CONCLUSIONS
Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow-up of mucosal and neuromuscular findings that do not respond to medical management.
Postma
Gregory N
GN
Department of Otolaryngology, Center for Voice and Swallowing Disorders, Medical College of Georgia, Augusta, Georgia, USA. gpostma@mcg.edu
McGuirt
W Frederick
WF
Butler
Susan G
SG
Rees
Catherine J
CJ
Crandall
Heather L
HL
Tansavatdi
Kristina
K
D000328:Adult; D001193:Arytenoid Cartilage / Q000503:physiopathology; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D005260:Female; D006099:Granuloma / Q000453:epidemiology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007818:Laryngeal Diseases / Q000453:epidemiology* / Q000503:physiopathology; D007819:Laryngeal Edema / Q000453:epidemiology / Q000503:physiopathology; D007820:Laryngeal Mucosa / Q000503:physiopathology; D007829:Laryngostenosis / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D014456:Ulcer / Q000453:epidemiology / Q000503:physiopathology; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000503:physiopathology