SUMMARY
Objective
Deglutition, speech production, and airway protection are extraordinarily complex,
interrelated functions that are coordinated, in large part, by the motor and sensory
innervation of CN X. Previous studies assessing the relationship between neurogenic
voice disorders and dysphagia have focused on the risk of aspiration due to glottic
insufficiency and the association of vocal fold hypomobility (VFH) with systemic neurologic
disease. The purpose of this study was to investigate the relationship between VFH
disorders and ineffective esophageal motility (IEM).
Methods
Adult voice patients who underwent laryngeal electromyography (LEMG) and dual 24-hour
pH impedance with high-resolution manometry (HRM) testing were included in the study.
Subjects were assigned to one of two groups based on the presence or absence of moderate-to-severe
RLN and/or SLN VFH (Mo-SLNH/RLNH) using results from six muscle LEMG tests. In subjects
with Mo-SLNH/RLNH, there was 0–60% muscle recruitment on LEMG, whereas control subjects
in the non-Mo-SLNH/RLNH group demonstrated 61–100% muscle recruitment. Analysis of
mild-to-severe VFH (80% muscle recruitment or less) was also performed in a similar
manner. The prevalence of IEM, defined using Chicago Classification Version 4.0 (CCv4.0),
was compared between groups, as were HRM parameters.
Results
One hundred sixty-two subjects were included (37.7% male/62.3% female, mean age of
43.88 ± 17.285). No differences in IEM prevalence were found when stratifying for
cases of mild-to-severe VFH. However, there was significantly higher percentage of
IEM in those with Mo-SLNH/RLNH. Mo-SLNH/RLNH subjects demonstrated higher rates of
weak swallows and inefficient swallows, as well as lower IBP and UES residual pressures
on HRM.
Conclusions
Patients with Mo-SLNH/RLNH demonstrated a significantly higher prevalence of IEM.
Those with mild-to-severe VFH did not. Higher rates of ineffective and weak swallows,
and lower IBP and UES residual pressures among Mo-SLNH/RLNH subjects suggest a possible
connection between Mo-SLNH/RLNH and IEM disorders. These manometric differences were
more prominent with sub-stratification of the Mo-SLNH/RLNH group by IEM. Additional
research is advised.
Key Words
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Article info
Publication history
Published online: April 20, 2023
Accepted:
February 13,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
