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Advancing Laryngeal Adductor Reflex Testing Beyond Sensory Threshold Detection.

Teresa E Lever1, Ashley M Kloepper2, Ian Deninger2

  • 1Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA. levert@health.missouri.edu.

Dysphagia
|October 23, 2021
PubMed
Summary

The laryngeal adductor reflex (LAR) shows varied motor responses, with not all stimuli causing complete glottic closure. This study characterizes LAR motion dynamics, offering potential biomarkers for airway protection and dysphagia risk.

Keywords:
DysphagiaFlexible endoscopic evaluation of swallowing with sensory testing (FEESST)Flexible endoscopyGlottic closure reflexSwallowing

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Area of Science:

  • Otolaryngology
  • Neurology
  • Speech-Language Pathology

Background:

  • Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) assesses airway integrity via the laryngeal adductor reflex (LAR).
  • Current FEESST protocols focus on sensory thresholds, with limited understanding of the LAR's motor response.
  • Characterizing LAR motor dynamics is crucial for refining airway protective reflex assessments.

Purpose of the Study:

  • To characterize normative laryngeal adductor reflex (LAR) motion dynamics in healthy adults.
  • To evaluate the motor response variability and glottic closure efficacy during LAR.
  • To explore the potential of LAR dynamics as biomarkers for laryngeal pathology and dysphagia.

Main Methods:

  • Utilized a prototype high-pressure syringe-based air pulse device for stimulus delivery.
  • Employed VFtrack™ analytic software to track vocal fold (VF) motion in endoscopic videos.
  • Quantified LAR motion dynamics in response to suprathreshold air pulse stimuli (40 and 60 mm Hg) in 20 healthy participants.

Main Results:

  • Identified both variant and invariant subcomponents within the LAR motor response.
  • Observed that only a fraction of suprathreshold stimuli resulted in complete glottic closure during the LAR.
  • Demonstrated the feasibility of objectively quantifying LAR motion dynamics with the developed system.

Conclusions:

  • The study highlights variability in the LAR motor response, suggesting potential for refined diagnostic capabilities.
  • Findings indicate that complete glottic closure is not consistently achieved even with suprathreshold stimuli.
  • Further research into LAR biomarkers could improve the assessment of laryngeal function and predict aspiration pneumonia risk.