HSC Section 6 Nov2016 Green Book

causing UVFI. Also, in an effort to keep the groups as homogenous as possible, the sample size was small. However, the groups that were chosen were intended to represent individuals with UVFI limited to vagus nerve injury. None of the individuals underwent a vocal fold medialization procedure prior to study, and all individu- als presented with a dysphagia complaint. In addition, this study was retrospective, so a future prospective investigation with a larger sample size is required to confirm these results. CONCLUSION Individuals with UVFI of iatrogenic and idiopathic etiologies with subjective dysphagia demonstrate objec- tive evidence of pharyngeal weakness. The increased prevalence of aspiration in this population may not be solely the result of impaired airway protection. BIBLIOGRAPHY 1. Chen HC, Jen YM, Wang CH, Lee JC, Lin YS. Etiology of vocal cord paral- ysis. ORL J Otorhinolaryngol Relat Spec 2007;69:167–171. 2. Leder SB, Suiter DM, Duffey D, Judson BL. Vocal fold immobility and aspiration status: a direct replication study. Dysphagia 2012;27:265– 270. 3. Heitmiller RF, Tseng E, Jones B. Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment. Dysphagia 2000;15:184–187. 4. Jang YY, Lee SJ, Jeon JY, Lee SJ. Analysis of video fluoroscopic swallow- ing study in patients with vocal cord paralysis. Dysphagia 2012;27:185– 190. 5. Tabaee A, Murry T, Zschommler A, Desloge RB. Flexible endoscopic evalu- ation of swallowing with sensory testing in patients with unilateral vocal fold immobility: incidence and pathophysiology of aspiration. Laryngoscope 2005;115:565–569. 6. Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with uni- lateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhinol Laryngol 2002;111:672–679. 7. Yip HT, Leonard R, Kendall, KA. Impact of vocal fold medialization on pharyngeal transit time and incidence of aspiration. Otolaryngol Head Neck Surg 2004; 131 8. Kendall K, McKenzie S, Leonard R. Dynamic swallow study: objective measures and normative data. In: Leonard R, Kendall K, eds. Dyspha- gia Assessment and Treatment Planning: A Team Approach . San Diego, CA: Singular Publishing; 1998. 9. Leonard R, Rees CJ, Belafsky P, Allen J. Fluoroscopic surrogate for pha- ryngeal strength: the pharyngeal constriction ratio (PCR). Dysphagia 2011;26:13–17.

competence influence the increased prevalence of aspira- tion observed in patients with UVFI. The results of the present study confirm the quali- tative findings of Jang et al. with objective data. In that study, individuals with UVFI of peripheral origin (i.e., recurrent laryngeal nerve injury, vagus nerve injury, or idiopathic etiologies) presented with subjective sugges- tion of abnormal laryngeal elevation and epiglottic inver- sion, residue in the valleculae, residue in the pyriform sinuses, and aspiration. 4 The percentage of aspiration in this study was also comparable to previous studies, which identified aspira- tion in approximately 33% to 42% of individuals with UVFI. 2–5 It is important to note that the present study was performed in an outpatient tertiary care center and most of the previous work evaluating aspiration in patients with UVFI was performed in acute care set- tings. Although information about the length of time from the onset of vocal fold immobility was not available in these studies, we suspect that the individuals included in the present investigation may have had a more prolonged duration of UVFI in comparison to pre- vious work. Nonetheless, the percentage of aspiration in the current investigation was similar to previous findings. When evaluating UVFI between groups, the only significant finding was total pharyngeal transit time. This may be the result of a higher vagal injury in the idiopathic group, compared to the iatrogenic group. How- ever, this confirmed that, although the iatrogenic group was more likely isolated to recurrent laryngeal nerve and/or superior laryngeal nerve injury than the idio- pathic group, the finding of increased PCR did not vary significantly between groups. Additionally, the iatrogenic group was approaching significance compared to the con- trol group, and significance may be achieved with a larger sample size. Therefore, pharyngeal weakness may exist in individuals with UVFI of both idiopathic and iatrogenic etiologies. This study was not without limitations. Electromy- ography was not utilized to determine the site of lesion

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Domer et al.: PCR and UES Opening in UVFI

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