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the idiopathic group and the control group. There was not a significant difference between the iatrogenic and the control group. Thirty-eight percent of individuals with idiopathic UVFI and 35% of individuals with iatrogenic UVFI aspi- rated at least once during the videofluoroscopic swallow study. There was not a significant difference between either of the UVFI groups ( P > 0.05); however, there was a significant difference between the idiopathic group and control group ( P < 0.05), as well as the iatrogenic group and control group ( P < 0.05). UVFI Group Compared With the Control Group The mean UESmax opening was 0.82 ( 6 0.04) cm for the UVFI group compared to 1.00 ( 6 0.05) cm for controls ( P > 0.05 see Table III). The pharyngeal constriction ratio was 0.14 ( 6 0.02) for the UVFI group compared to 0.06 ( 6 0.01) for controls ( P < 0.05). Larynx to hyoid approxi- mation was 1.35 ( 6 0.11) cm for the UVFI group and 1.42 ( 6 0.12) cm for the control group ( P > 0.05). The mean for hyoid displacement was 1.89 ( 6 0.12) cm for the UVFI group and 2.22 ( 6 0.17) cm for the control group ( P > 0.05). The mean TPT was 1.78 ( 6 0.32) seconds for the UVFI group and 1.01 ( 6 0.06) seconds for the control group ( P < 0.05). Thirty-six percent of individuals with UVFI aspirated at least once during the videofluoroscopic swallow study compared to 0% of controls ( P < 0.05). DISCUSSION The data in the current investigation provided evi- dence to suggest that individuals with UVFI of iatro- genic and idiopathic etiologies may present with additional biomechanical findings that may increase the prevalence of aspiration. The group of individuals with UVFI of idiopathic and iatrogenic etiologies demon- strated significantly prolonged TPT and elevated PCRs, suggesting delayed bolus transit and pharyngeal weak- ness. Additionally, individuals with UVFI of idiopathic etiology demonstrated significantly prolonged TPT, increased PCR (i.e., pharyngeal weakness), and decreased UESmax compared to controls. These findings support the notion that factors other than glottal

TABLE II. Mean, Standard Deviation, and P Value for Iatrogenic and Idio- pathic Groups.

Iatrogenic UVFI vs. Idiopathic UVFI

Iatrogenic (n 5 17) Mean (SD)

Idiopathic (n 5 8) mean (SD)

P Value

UESmax (cm)

0.85 (0.05)

0.76 (0.07)

1.00

PCR

0.12 (0.02)

0.18 (0.04)

0.34

HLx (cm)

1.25 (0.14) 1.91 (0.16)

1.58 (0.15) 1.84 (0.16)

0.55 1.00

Hmax (cm)

TPT (seconds)

1.36 (0.09)

2.66 (0.93)

0.04

a 5 0.01. *Statistical significance.

HLx 5 hyoid to larynx approximation; Hmax 5 hyoid excursion; PCR 5 pharyngeal constriction ratio; SD 5 standard error; TPT 5 total pha- ryngeal transit time; UESmax 5 upper esophageal sphincter opening; UVFI 5 unilateral vocal fold immobility.

have dysphagia complaints that could be explained by any other etiology in their medical history). The etiology of UVFI was identified as iatrogenic in 17 individuals and idiopathic in eight individuals. The cohort was 52% female with a mean age of 61 ( 6 14) years. Comparison of the Idiopathic Group, Iatrogenic Group, and Control Group The idiopathic group (n 5 8) was 50% female with a mean age of 64 ( 6 14) years (Table II). The iatrogenic group (n 5 17) was 53% female with a mean age of 60 years ( 6 14) years. There was no difference in age or gender between groups ( P > 0.05). The mean UESmax was 0.76 ( 6 0.07) cm for the idi- opathic group, 0.85 ( 6 0.05) cm for the iatrogenic group, and 1.0 ( 6 0.05) cm for the control group. There were no significant differences between any groups for UESmax ( P > 0.01). The PCR was 0.18 ( 6 0.04) for the idiopathic group, 0.12 ( 6 0.02) for the iatrogenic group, and 0.06 ( 6 0.01) for the control group. PCR was significantly greater for the idiopathic group compared with the control group ( P < 0.01). PCR for the iatrogenic group was not signifi- cant, but less than the control group ( P > 0.01). There was not a significant difference between the idiopathic or iatrogenic groups ( P > 0.01). The HLx was 1.58 ( 6 0.15) cm for the idiopathic group, 1.25 ( 6 0.14) cm for the iatrogenic group, and 1.42 ( 6 0.12) cm for the control group ( P > 0.01). There were no significant differences between any groups for HLx ( P > 0.01). The Hmax was 1.84 ( 6 0.16) cm for the idiopathic group, 1.91 ( 6 0.16) cm for the iatrogenic group, and 2.22 ( 6 0.18) cm for the control group ( P > 0.01). There were no significant differences between any groups for Hmax ( P > 0.01). The mean TPT was 2.66 ( 6 0.93) seconds for the idi- opathic group, 1.36 ( 6 0.09) seconds for the iatrogenic group, and 1.01 ( 6 0.06) seconds for the control group ( P > 0.01). There was a significant difference between the idiopathic UVFI and iatrogenic UVFI groups ( P < 0.01). There was a significant difference between

TABLE III. Mean, Standard Deviation, and P Value for UVFI Group and Controls.

UVFI (n 5 25) Mean (SD)

Controls (n 5 25) Mean (SD)

UVFI vs. Controls

P Value

UESmax (cm)

0.82 (0.05)

1.00 (0.05)

0.94

PCR

0.14 (0.02) 1.35 (0.11)

0.06 (0.01) 1.42 (0.12)

0.03*

HLx (cm)

0.94

Hmax (cm)

1.89 (0.12)

2.21 (0.17)

0.16

TPT (seconds)

1.78 (0.32)

1.01 (0.06)

0.02*

a 5 0.05 *Statistical significance.

Laryngoscope 124: October 2014

Domer et al.: PCR and UES Opening in UVFI

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