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

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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.

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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.

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Authors and Affiliations

  1. Rehabilitation Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Asako Kaneoka, Haruhi Inokuchi & Nobuhiko Haga

  2. Department of Speech, Language & Hearing Sciences, Boston University Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, USA

    Asako Kaneoka, Jessica M. Pisegna, Cara E. Stepp & Susan E. Langmore

  3. Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Rumi Ueha, Takao Goto & Takaharu Nito

  4. Department of Biostatistics, Boston University School of Public Health, Crosstown Building, 801 Massachusetts Avenue 3rd Floor, Boston, MA, 02118, USA

    Cara E. Stepp & Michael P. LaValley

  5. Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Moakley Building, 830 Harrison Avenue, Boston, MA, 02118, USA

    Susan E. Langmore

Authors
  1. Asako Kaneoka
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  2. Jessica M. Pisegna
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  3. Haruhi Inokuchi
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  4. Rumi Ueha
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  5. Takao Goto
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  6. Takaharu Nito
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  7. Cara E. Stepp
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  8. Michael P. LaValley
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  9. Nobuhiko Haga
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  10. Susan E. Langmore
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Correspondence to Asako Kaneoka.

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Kaneoka, A., Pisegna, J.M., Inokuchi, H. et al. Relationship Between Laryngeal Sensory Deficits, Aspiration, and Pneumonia in Patients with Dysphagia. Dysphagia 33, 192–199 (2018). https://doi.org/10.1007/s00455-017-9845-8

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  • DOI: https://doi.org/10.1007/s00455-017-9845-8

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