Abstract

BackgroundLaryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity.MethodsWe designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes.ResultsWe initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducting the air-pulses and the site of impact. To control all of these factors, an LPEER consisting of an air-pulse generator and an endoscopic laser range-finder was designed and manufactured. We assessed the precision and accuracy of the LPEER’s stimulus and range-finder according to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air-pulses and range-finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range-finder measurement error of <1 mm. The tests in patients demonstrated obtainable and reproducible thresholds for the laryngeal adductor, cough and gag reflexes.ConclusionsThe new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo-pharyngeal reflexes.

Highlights

  • Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dyspha‐ gia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders

  • The number of years of life lost (YLLs) due to premature mortality as a result of Obstructive sleep apnea (OSA) is estimated to be approximately 41 million per year, which was estimated from a total of 256 million YLLs resulting from all-cause mortality [7] and the population attributable fraction (PAF) of OSA among all deaths calculated from the meta-analysis conducted by Wang (PAF = 0.16) [6]

  • We explored the potential factors affecting the reliability of the stimuli used to measure the LPMS, and we designed and developed a laryngo-pharyngeal endoscopic esthesiometer and range-finder (LPEER) consisting of an air-pulse generator and an endoscopic laser range-finder

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Summary

Introduction

Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dyspha‐ gia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. The central nervous system controls many of the varied functions of the upper aerodigestive tract using the information provided by the mechanoreceptors of this tract’s mucosa [1]. Obstructive sleep apnea (OSA) patients have lower sensory capacity (higher sensory thresholds) throughout the laryngo-pharyngeal tract [4, 5], which impairs the reflex response of the central nervous system to regulate the tone of the upper airway dilatator muscles to maintain airway patency [4].

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