FEES-based assessment of pharyngeal hypesthesia-Proposal and validation of a new test procedure.
FEES
FEESST
dysphagia
laryngeal adductor reflex
pharyngeal hypesthesia
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
20
05
2019
revised:
09
07
2019
accepted:
18
07
2019
pubmed:
6
8
2019
medline:
22
9
2020
entrez:
6
8
2019
Statut:
ppublish
Résumé
Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005). Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
Sections du résumé
BACKGROUND
Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia.
METHODS
A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL.
KEY RESULTS
The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005).
CONCLUSION AND INFERENCES
Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13690Informations de copyright
© 2019 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.
Références
Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49-59.
Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia. 2010;25(4):323-333.
Alvarez-Berdugo D, Rofes L, Casamitjana JF, Padron A, Quer M, Clave P. Oropharyngeal and laryngeal sensory innervation in the pathophysiology of swallowing disorders and sensory stimulation treatments. Ann N Y Acad Sci. 2016;1380(1):104-120.
Mu L, Sanders I. Sensory nerve supply of the human oro- and laryngopharynx: a preliminary study. Anat Rec. 2000;258(4):406-420.
Zur KB, Mu L, Sanders I. Distribution pattern of the human lingual nerve. Clin Anat. 2004;17(2):88-92.
Doty RL, Cummins DM, Shibanova A, Sanders I, Mu L. Lingual distribution of the human glossopharyngeal nerve. Acta Otolaryngol. 2009;129(1):52-56.
Sanders I, Mu L. Anatomy of the human internal superior laryngeal nerve. Anat Rec. 1998;252(4):646-656.
Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81(2):929-969.
Teismann IK, Dziewas R, Steinstraeter O, Pantev C. Time-dependent hemispheric shift of the cortical control of volitional swallowing. Hum Brain Mapp. 2009;30(1):92-100.
Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85(2):938-950.
Hamdy S, Mikulis DJ, Crawley A, et al. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol. 1999;277(1):G219-G225.
Hamdy S, Aziz Q, Rothwell JC, et al. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996;2(11):1217-1224.
Furlong PL, Hobson AR, Aziz Q, et al. Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain. NeuroImage. 2004;22(4):1447-1455.
Dziewas R, Sörös P, Ishii R, et al. Neuroimaging evidence for cortical involvement in the preparation and in the act of swallowing. NeuroImage. 2003;20(1):135-144.
Teismann IK, Steinstraeter O, Stoeckigt K, et al. Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing. BMC Neurosci. 2007;8:62.
Muhle P, Claus I, Marian T, et al. Introducing a virtual lesion model of dysphagia resulting from pharyngeal sensory impairment. Neurosignals. 2018;26(1):1-10.
Setzen M, Cohen MA, Mattucci KF, Perlman PW, Ditkoff MK. Laryngopharyngeal sensory deficits as a predictor of aspiration. Otolaryngol Head Neck Surg. 2001;124(6):622-624.
Ding P, Campbell-Malone R, Holman SD, et al. Unilateral superior laryngeal nerve lesion in an animal model of dysphagia and its effect on sucking and swallowing. Dysphagia. 2013;28(3):404-412.
Sulica L, Hembree A, Blitzer A. Swallowing and sensation: evaluation of deglutition in the anesthetized larynx. Ann Otol Rhinol Laryngol. 2002;111(4):291-294.
Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Association between laryngeal sensation, pre-swallow secretions and pharyngeal residue on fiberoptic endoscopic examination of swallowing. Dysphagia. 2019;34(4):548-555. https://doi.org/10.1007/s00455-019-10001-4
Onofri S, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256-261.
Marian T, Schröder J, Muhle P, et al. Pharyngolaryngeal sensory deficits in patients with middle cerebral artery infarction: lateralization and relation to overall dysphagia severity. Cerebrovasc Dis Extra. 2017;7(3):130-139.
Mu L, Sobotka S, Chen J, et al. Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol. 2013;72(7):614-623.
Aviv JE. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med. 1997;103(5A):74S-76S.
Ortega O, Martin A, Clave P. Diagnosis and management of oropharyngeal dysphagia among older persons, state of the art. J Am Med Dir Assoc. 2017;18(7):576-582.
Borders JC, Fink D, Levitt JE, et al. Relationship between laryngeal sensation, length of intubation, and aspiration in patients with acute respiratory failure. Dysphagia. 2019. https://doi.org/10.1007/s00455-019-09980-1 [Epub ahead of print].
Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010;137(2):326-332.
Dziewas R, auf dem Brinke M, Birkmann U, et al. Safety and clinical impact of FEES - results of the FEES-registry. Neurol Res Pract. 2019;1(1):16.
Warnecke T, Oelenberg S, Teismann I, et al. Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov Disord. 2010;25(9):1239-1245.
Warnecke T, Suttrup I, Schröder JB, et al. Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-Levodopa-test. Parkinsonism Relat Disord. 2016;28:100-106.
Teramoto S, Matsuse T, Fukuchi Y, Ouchi Y. Simple two-step swallowing provocation test for elderly patients with aspiration pneumonia. Lancet. 1999;353(9160):1243.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-163.
Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Arch Phys Med Rehabil. 2000;81(11):1517-1519.
Warnecke T, Teismann I, Meimann W, et al. Assessment of aspiration risk in acute ischaemic stroke-evaluation of the simple swallowing provocation test. J Neurol Neurosurg Psychiatry. 2008;79(3):312-314.
Tejima C, Kikutani T, Takahashi N, Tamura F, Yoshida M. Application of simple swallowing provocation test with fiberoptic endoscopic evaluation of swallowing in a cross-sectional study. BMC Geriatr. 2015;15:48.
Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol. 1993;102(10):777-780.
Domer AS, Kuhn MA, Belafsky PC. Neurophysiology and clinical implications of the laryngeal adductor reflex. Curr Otorhinolaryngol Rep. 2013;1(3):178-182.
Kim T, Goodhart K, Aviv JE, et al. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol. 1998;107(5 Pt 1):378-387.
Aviv JE, Spitzer J, Cohen M, Ma G, Belafsky P, Close LG. Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration. Laryngoscope. 2002;112(2):338-341.
Ku P, Vlantis AC, Leung SF, et al. Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma. Laryngoscope. 2010;120(2):223-228.
Cunningham JJ, Halum SL, Butler SG, Postma GN. Intraobserver and interobserver reliability in laryngopharyngeal sensory discrimination thresholds: a pilot study. Ann Otol Rhinol Laryngol. 2007;116(8):582-588.
Kaneoka A, Krisciunas GP, Walsh K, Raade AS, Langmore SE. A comparison of 2 methods of endoscopic laryngeal sensory testing: a preliminary study. Ann Otol Rhinol Laryngol. 2015;124(3):187-193.
Leow LP, Beckert L, Anderson T, Huckabee M-L. Changes in chemosensitivity and mechanosensitivity in aging and Parkinson's disease. Dysphagia. 2012;27(1):106-114.
Kaneoka A, Pisegna JM, Krisciunas GP, et al. Variability of the pressure measurements exerted by the tip of laryngoscope during laryngeal sensory testing: a clinical demonstration. Am J Speech Lang Pathol. 2017;26(3):729-736.