Abstract
BackgroundSeveral studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. However, no previous studies have evaluated the accumulation of saliva and swallowing dynamics.ObjectiveThe objective of this study was to examine the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE).MethodsThis retrospective study investigated 47 patients with dysphagia who underwent VF and VE on the same day. Saliva accumulation in the pharynx was assessed on VE and classified by the Murray secretion scale. Pharyngeal residue was assessed on VF. In addition, displacement of the hyoid bone and larynx on swallowing and the opening size of the esophageal orifice were measured, and contact between the base of the tongue and the posterior pharyngeal wall was examined on VF.ResultsModerate correlations were found between saliva accumulation and perpendicular displacement of the larynx and upper esophageal sphincter opening. The percentage of patients showing contact between the base of the tongue and the posterior pharyngeal wall was significantly greater in those with a saliva accumulation score of 0 or 1.ConclusionLess laryngeal elevation and upper esophageal sphincter opening and absence of contact between the base of the tongue and the posterior pharyngeal wall when swallowing tended to result in accumulation of saliva in the pharynx.
Highlights
Saliva in the oral cavity is an important component in swallowing, saliva plays a critical role as a medium for carrying oral bacteria to the lower respiratory tract.(Inglis, Sherratt, Sproat, Gibson, & Hawkey, 1993) Several studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. (Link, Willging, Miller, Cotton, & Rudolph, 2000; Mikushi et al, 2015; Murray, Langmore, Ginsberg, & Dostie, 1996; Takahashi, Kikutani, Tamura, Groher, & Kuboki, 2012), (Takahashi et al, 2012) in a study in nursing care facilities, showed that aspiration of saliva detected by videoendoscopy was a significant risk factor for pneumonia
The present study examined the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE)
We evaluated the accumulation of saliva in the pharynx from VE, the pharyngeal residue of test food, the displacement of the hyoid bone and larynx on swallowing, the opening of the esophageal orifice, and the contact between the base of the tongue and the posterior pharyngeal wall from VF
Summary
Saliva in the oral cavity is an important component in swallowing, saliva plays a critical role as a medium for carrying oral bacteria to the lower respiratory tract.(Inglis, Sherratt, Sproat, Gibson, & Hawkey, 1993) Several studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. (Link, Willging, Miller, Cotton, & Rudolph, 2000; Mikushi et al, 2015; Murray, Langmore, Ginsberg, & Dostie, 1996; Takahashi, Kikutani, Tamura, Groher, & Kuboki, 2012), (Takahashi et al, 2012) in a study in nursing care facilities, showed that aspiration of saliva detected by videoendoscopy was a significant risk factor for pneumonia. Saliva in the oral cavity is an important component in swallowing, saliva plays a critical role as a medium for carrying oral bacteria to the lower respiratory tract.(Inglis, Sherratt, Sproat, Gibson, & Hawkey, 1993) Several studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. Decreased sensitivity of the oropharynx might be responsible for accumulation of saliva in the pharynx and subsequent silent aspiration and laryngeal penetration of saliva. We have hypothesized that reduced function of the oropharynx (i.e., incomplete pharyngeal constriction and impaired opening of the upper esophageal sphincter) may lead to accumulation or aspiration of saliva, similar to aspiration of food. The present study examined the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE)
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