Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing

Reduced laryngeal sensation and accumulated pharyngeal secretions are known predictors of aspiration. Yet, their association with residue has not been fully explored. One Hundred and ten fiberoptic endoscopic examination of swallowing (FEES) examinations were retrospectively analyzed. Murray's secretion scale (MSS) for secretion stasis and laryngeal sensation were tested for association with residue severity (Yale pharyngeal residue severity rating scale, YPR-SRS) and the number of swallows required to clear the bolus. The bolus challenges of each consistency (liquid, puree and solid) with the highest PAS and YPR-SRS scores were analyzed. Impaired laryngeal sensation (ILS) and MSS were both independently significantly associated with higher YPR-SRS for all consistencies examined. Mean YPR-SRS for patients with both ILS and secretion stasis was respectively 2.4 +/- 1.1, 2.5 +/- 1.2, 2.4 +/- 1.2 for liquid, puree and solids in the vallecula, and 2.9 +/- 1.3, 2.3 +/- 1.1, 2 +/- 1 for pyriform sinuses residue compared to 1.8 +/- 0.7, 1.6 +/- 1, 1.6 +/- 1 for vallecular residue and 1.8 +/- 0.8, 1.4 +/- 0.8, 1.3 +/- 0.7 for pyriform sinus residue of patients with normal laryngeal sensation and no stasis (p<0.05 for all except liquids in vallecula). The combined findings of both ILS and MSS >= 1 had a sensitivity of 25.9%, specificity of 94.2%, positive predictive value (PPV) of 83.3% and negative predictive value (NPV) of 53.3% for prediction of pharyngeal residue and a sensitivity of 58.3%, specificity of 88.8%, PPV of 39.9% and a NPV of 94.6% for prediction of aspiration. Both ILS and MSS were significantly associated with increased number of swallows required to clear a bolus. Abnormal laryngeal sensation and secretion stasis are associated with pharyngeal residue severity and reduced residue clearing on FEES.