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Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility
Author(s) -
Domer Amanda S.,
Leonard Rebecca,
Belafsky Peter C.
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24779
Subject(s) - medicine , dysphagia , etiology , swallowing , weakness , reflux , confounding , larynx , cohort , surgery , pharynx , gastroenterology , disease
Objectives/Hypothesis To evaluate pharyngeal strength and upper esophageal sphincter opening in patients with unilateral vocal fold immobility (UVFI). Study Design Case control study. Methods Charts of individuals with UVFI who underwent a videofluoroscopic swallow study were reviewed. To exclude confounding variables associated with pharyngeal weakness, inclusion was limited to patients with iatrogenic and idiopathic UVFI. Data abstracted included patient demographics, etiology of UVFI, pharyngeal constriction ratio (PCR), and upper esophageal sphincter (UES) opening (UESmax). Data were compared to age/gender‐matched controls with no history of dysphagia or UVFI. Discrete variables were analyzed using a chi‐square test of independence, and an independent samples t test was used to compare the UVFI and control groups ( P = 0.05). A one‐way analysis of variance (ANOVA) was used to compare iatrogenic and idiopathic UVFI groups. Results The mean age of the cohort (n = 25) was 61 (±14 SD) years and 52% was female. The etiologies of UVFI were iatrogenic (n = 17) and idiopathic (n = 8). Thirty‐eight percent of UVFI patients (n = 25) aspirated compared to 0% of controls ( P < 0.05). The mean PCR for the UVFI group was 0.14 (±0.02) compared to 0.06 (±.01) for controls ( P < 0.05). The mean UESmax for the UVFI group was 0.82 cm (±0.04) compared to 1.0 cm (±0.05) for controls ( P > 0.05). Conclusion Individuals with UVFI of iatrogenic and idiopathic etiologies with subjective dysphagia demonstrate objective evidence of pharyngeal weakness. The increased prevalence of aspiration in this population may not be solely the result of impaired airway protection. Level of Evidence 3b. Laryngoscope 124:2371–2374, 2014