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Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients

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Abstract

Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for associations with major alterations in swallowing safety (pharyngeal residues, penetration, and aspiration). We evaluated the discriminative capacity of the LPMS test using ROC curves and the area under the curve (AUC–ROC) and its relationship with the eight-point penetration–aspiration scale (PAS) using the Spearman’s ρ correlation coefficient (SCC). We found a positive correlation between the PAS and LART (SCC 0.47; P < 0.001), CRT (SCC 0.46; P < 0.001) and GRT (SCC 0.34; P = 0.002). The AUC–ROC values for detecting a PAS ≥7 were as follows: LART, 0.83 (P < 0.0001); CRT, 0.79 (P < 0.0001); GRT, 0.72 (P < 0.0001). In this study, the LPEER showed good accuracy for evaluating LPMS. These results justify further validation studies in independent populations.

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Funding

This study was funded by Colciencias, Colombia (Grant 768-2013) and by the University of La Sabana Chia, Colombia (Grant MED-164-2013). It also received support from the University of Navarra, Pamplona, Spain.

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Authors and Affiliations

  1. Unidad de Formación Clínica, School of Medicine, University of Navarra, Irunlarrea 1, 31080, Pamplona, Navarre, Spain

    Luis F. Giraldo-Cadavid & Secundino Fernandez

  2. Research Department and Clinica Universidad de La Sabana, School of Medicine, University of La Sabana, Chia, Cundinamarca, Colombia

    Luis F. Giraldo-Cadavid, Felipe Rueda, Natalia Castaneda & Jorge I. Balaguera

  3. Fundacion Neumologica Colombiana, Bogotá, DC, Colombia

    Luis F. Giraldo-Cadavid & Nelson Paez

  4. School of Sciences, University of Navarra, Pamplona, Navarre, Spain

    Javier Burguete

  5. Rehabilitation Department, Clinica Universidad de La Sabana, Chia, Cundinamarca, Colombia

    Ana M. Galvis

  6. School of Engineering, Escuela Colombiana de Ingeniería, Bogota, Cundinamarca, Colombia

    Mario Arbulu

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  1. Luis F. Giraldo-Cadavid
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  9. Secundino Fernandez
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Correspondence to Luis F. Giraldo-Cadavid.

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Conflict of interest

Luis F. Giraldo-Cadavid, Javier Burguete, Mario Arbulu, and Secundino Fernandez have a Patent granted by the Colombian’s Superintendencia de Industria y Comercio to the Laryngo-pharyngeal Endoscopic Esthesiometer and Range Finder (LPEER) (No. 13-121843-00003-0000), a PCT (International Application No. PCT/IB2014/061063) and a US Patent in process. University of La Sabana (Colombia) is the owner of the financial rights for this patent and the authors own the intellectual property over this patent.

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Institutions where the work was performed: Pulmonary Medicine Service and the Rehabilitation Department of the Clinica University of La Sabana, Chia, Cundinamarca, Colombia. Interventional Pulmonology Division, Fundacion Neumologica Colombiana, Bogota, DC, Colombia.

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Giraldo-Cadavid, L.F., Burguete, J., Rueda, F. et al. Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients. Dysphagia 33, 15–25 (2018). https://doi.org/10.1007/s00455-017-9826-y

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