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Respiratory-Swallow Pattern Following Total Laryngectomy

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Abstract

The goal of this study was to further characterize respiratory patterns in total laryngectomees with attention to respiratory-swallow pattern as it relates to presence/absence of tracheoesophageal puncture (TEP) and bolus consistency. It was hypothesized that participants with TEP would exhibit respiratory-swallow patterns that were significantly different than those without TEP and that bolus consistency (thin or solid) would modulate respiratory-swallow pattern. Data were collected from 12 adults (8 male), aged 46–67 years (mean 57) status post total laryngectomy (1–30 years; average 6 years). Those actively receiving chemoradiation, with history of esophageal cancer, with neurologic disease, with history of lung cancer, with known or suspected recurrence of head and neck cancer (HNC), or with severe cognitive deficits were excluded. Laryngectomy participants were asked to swallow three sips of water and three bites of graham cracker. Submental surface EMG activity was used to detect swallows and a custom stoma mask in line with a pneumotachograph measured airflow during the swallows. Non-parametric Mann–Whitney test for differences was used to detect significance for our dependent variables, TEP or bolus consistency and independent variables, respiratory-swallow pattern. Laryngectomee’s showed preference for swallow during inspiration which is inconsistent with the expiratory pattern preference found in healthy adults with intact larynges by McFarland et al. (Respir Physiol Neurobiol 234:89–96, 2016) but consistent with the pattern preference for inspiration (or non-dominant respiratory-swallow phase pattern) found in the HNC population at-large by Brodsky et al. (J Appl Physiol 112(10):1698–1705, 2012). No significant difference was found in swallow pattern with regards to presence/absence of TEP or bolus consistency.

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Funding

This study was funded by NIH SPARC (Grant No. OT2OD023854).

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Authors and Affiliations

  1. Department of Speech, Language and Hearing Sciences, University of Florida, 1600 Archer Road, P.O. Box 100174, Gainesville, FL, 32610, USA

    Amy Fullerton, Yuhan Mou & Karen Hegland

  2. Department of Otolaryngology Head and Neck Surgery, University of Florida, Gainesville, USA

    Natalie Silver & Neil Chheda

  3. Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, USA

    Donald Bolser

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  1. Amy Fullerton
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Correspondence to Amy Fullerton.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Florida Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for this study was received from the University of Florida Institutional Review Board for research involving human subjects.

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Fullerton, A., Mou, Y., Silver, N. et al. Respiratory-Swallow Pattern Following Total Laryngectomy. Dysphagia 35, 321–327 (2020). https://doi.org/10.1007/s00455-019-10031-y

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