Dysphagia

, Volume 33, Issue 2, pp 192–199 | Cite as

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

  • Asako Kaneoka
  • Jessica M. Pisegna
  • Haruhi Inokuchi
  • Rumi Ueha
  • Takao Goto
  • Takaharu Nito
  • Cara E. Stepp
  • Michael P. LaValley
  • Nobuhiko Haga
  • Susan E. Langmore
Original Article
First Online:
Received:
Accepted:

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.

Keywords

Laryngeal sensory deficits Dysphagia Deglutition Laryngeal adductor reflex Aspiration Pneumonia 
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Notes

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.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Asako Kaneoka
    • 1
    • 2
  • Jessica M. Pisegna
    • 2
  • Haruhi Inokuchi
    • 1
  • Rumi Ueha
    • 3
  • Takao Goto
    • 3
  • Takaharu Nito
    • 3
  • Cara E. Stepp
    • 2
    • 4
  • Michael P. LaValley
    • 4
  • Nobuhiko Haga
    • 1
  • Susan E. Langmore
    • 2
    • 5
  1. 1.Rehabilitation CenterThe University of Tokyo HospitalTokyoJapan
  2. 2.Department of Speech, Language & Hearing SciencesBoston University Sargent CollegeBostonUSA
  3. 3.Department of Otolaryngology and Head and Neck SurgeryGraduate School of Medicine, The University of TokyoTokyoJapan
  4. 4.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  5. 5.Department of Otolaryngology-Head and Neck SurgeryBoston University Medical CenterBostonUSA

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