Swallowing

Does ipsilateral false vocal fold removal influence swallowing after transoral laser cordectomy? – a FEES study

A. Burián1, K. Smatanová2, J. Girán3, I. Szanyi1                                                                                                                                          doi: 10.48095/ccorl2025S1_32

1 Department of Otorhinolaryngology and Head and Neck Surgery, University of Pécs, Clinical Centre, Pécs, Hungary

2 Department of Paediatrics, University of Pécs, Clinical Center, Pécs, Hungary

3 Department of Public Health Medicine, University of Pécs, Medical School, Pécs, Hungary

Introduction: ELS recommends removal of false vocal fold during “deeper” transoral laser cordectomies for better intraoperative tumor visualization. Nevertheless, false vocal fold resection may carry the risk of impaired swallowing. Aims: To investigate early and late impact of false vocal fold resection on swallowing using FEES after type III, IV and V transoral laser cordectomies. Materials and Methods: Fifteen patients with endoscopically resectable early glottic cancers (10 T1a, 2 T1b, 2 T2, 1 selected T3) underwent transoral laser cordectomy with ipsilateral false vocal fold removal. FEES was performed preoperatively, in the early and late postoperative period, respectively, establishing modified penetration-aspiration scale (mPAS) and pharyngeal residue severity scale (PRSS). Wilcoxon signed-rank test was used to assess differences among the investigated timepoints (P < 0.05 was deemed statistically significant). Laryngeal preservation and local recurrence were also noted. Results: 2 type III, 9 type IV, 2 type Va and 2 type Vd cordectomies were performed. Early postoperative mPASs changed significantly compared to preoperative values (P = 0,046). Difference between early and late postoperative mPASs was also significant (P = 0,046). There was no difference between preoperative and late postoperative mPASs (P = 1.0). Regarding pharyngeal residue, significant changes were noted in the early postoperative period compared to preoperative values (P = 0,002). Regarding late postoperative PRSSs, significant decrease was noted compared to the early postoperative status (P = 0,004). No remarkable difference was found between preoperative and late postoperative PRSSs (P = 0,317). One patient required definitive radiotherapy, while laryngeal preservation failed in another case due to advanced recurrence and lack of compliance. Conclusion: In our serie, ipsilateral false vocal fold removal during transoral laser cordectomy did not influence swallowing unfavorably in the long term neither by increased pharyngeal retention nor by increased penetration/aspiration risk. Investigation of cases without co-morbidities (diabetes, stroke) may be considerable to further confirm our observations. Nevertheless, TLC provided excellent laryngeal preservation.

Acoustic markers of dysphagia: correlating formant frequencies with swallowing dysfunction in neurodegenerative diseases

S. Capobianco1, L. Bastiani2, T. Giusti1, S. Berrettini1, A. Nacci1                                                                                              doi: 10.48095/ccorl2025S1_33

1 ENT, Audiology and Phoniatrics Unit, Pisa University Hospital, Pisa, Italy

2 Institute of Clinical Physiology, Epidemiology Section, National Research Council of Italy, Pisa, Italy

Introduction: The impairment of tongue propulsion and motility in neurodegenerative diseases affects both swallowing (dysphagia) and phonation (dysarthria) due to alterations in lingual propulsion and articulatory capacity. Aims: This study evaluates the potential of acoustic voice analysis to quantify these deficits, aiming to correlate articulatory alterations with swallowing dysfunctions by leveraging the relationship between acoustic formant frequencies and the effectiveness of tongue body movement. Methods: Eighty-nine patients with neurodegenerative diseases (46 M, 43 F; mean age = 64.1 ± 13.3 years) underwent acoustic analysis, extracting the first (F1) and second (F2) formants during sustained phonation of /a/, /i/, /e/, and /u/. Clinical swallowing assessments (using the DOSS, FOIS, and ASHA-NOMS scales) and fiberoptic endoscopic evaluation (using the Pooling score, Penetration-aspiration scale) were performed. Correlations between acoustic and dysphagia metrics were analyzed using Spearman’s correlation. A Structural equation model (SEM) integrated significant formant features into a Dysphagia formant index (DFI), whose predictive value was tested via ROC analysis on 174 healthy controls. Results: A significant correlation was found between F2 values, particularly for the vowels /e/ and /i/, and swallowing efficiency, as measured by the Pooling score for liquid, semi-solid, and solid consistencies. The DFI, incorporating the most significant formant values, demonstrated a reliable discriminative ability in identifying moderate-to-severe dysphagia across all consistencies, distinguishing it from absent or mild dysarthria, with a cut-off value of 3.79 (Se 82.8%; Sp 52.8%; AUC 0.772). Conclusions: Acoustic formant analysis during sustained vowels is significantly associated with tongue motility deficits in neurodegenerative diseases, reinforcing the link between dysarthria and oropharyngeal dysphagia. The DFI could aid early dysphagia screening, identifying patients requiring further clinical and/or instrumental assessment.

Prevalence and characteristics of dysphagia in adolescents with Down syndrome: a preliminary cross-sectional study

A. Duran                                                                                                                                                                doi: 10.48095/ccorl2025S1_34

Otolaryngology and Head and Neck Surgery, Dr. A. Y. Ankara Oncology Training and Research Hospital, Ankara, Türkiye

Introduction: Down syndrome (DS) is a genetic condition characterized by hypotonia, distinctive craniofacial features, and developmental delays, predisposing individuals to feeding and swallowing difficulties. While feeding challenges in young children with DS are well-documented, research focusing specifically on dysphagia in adolescents remains limited. Effective management of dysphagia in this population requires understanding the physiological changes of puberty, the increasing drive for independence, and the necessity of multidisciplinary care. Aims: This study aimed to determine the prevalence and characteristics of dysphagia in adolescents with DS using the validated Pediatric eating assessment tool-10. A secondary aim was to explore potential risk factors associated with swallowing difficulties. Materials and Methods: A cross-sectional study compared adolescents aged 10–19 with a DS diagnosis to a control group of typically developing peers. Dysphagia was assessed using the scale mentioned above, a validated screening questionnaire. Caregivers completed the scale and provided additional information regarding feeding behaviors and respiratory symptoms. Statistical analysis examined relationships between dysphagia severity, feeding behaviors, and a history of recurrent respiratory infections. Results: Preliminary findings reveal a high prevalence of dysphagia in adolescents with DS. 60% of the DS group exhibited clinically significant dysphagia based on scale scores, significantly higher than the control group. Commonly reported and significantly more prevalent difficulties in the DS group included prolonged mealtimes, coughing during feeding, and drooling. A history of lower respiratory tract infections was also significantly more prevalent in the DS group. Conclusions: Dysphagia is a prevalent, yet often under-recognized, challenge in adolescents with DS. Early identification of high-risk individuals is crucial for preventing complications such as malnutrition, aspiration-related respiratory issues (potentially leading to morbidity and even mortality), and associated social and financial burdens. Further research is needed to investigate long-term outcomes and optimize management strategies for dysphagia in this vulnerable population.

Effect on dissolution of phenytoin in opened-capsule form across various thickness of liquids and two common foods

R. Fong1, Z. Zuo2, M. K. L. Wong1                                                                                                                                                                              doi: 10.48095/ccorl2025S1_35

1 Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong

2 The Chinese University of Hong Kong, Hong Kong, Hong Kong

Introduction: Difficulties in swallowing medications in tablet or capsule form is common for patients with dysphagia. When alternative dosage forms are not available, it was common practice to modify solid oral dosage forms, by crushing, splitting, or opening capsules and mixing it with regular or thickened liquids. This have caused concerns in modified-release properties, deviation from dosage, and reduced bioavailability of medications due to reduced rate of dissolution and disintegration of medication in thickened liquid. Aims: The current study investigated the effect of dissolution of different thickness levels of liquids and two types of food on a common medication, Phenytoin, in capsule form. Methods: The study was an in vitro study. Phenytoin was obtained from Dilantin 100 mg in capsule form. The vehicles (IDDSI level 0–4 by starch and gum-based thickener, pudding and congee; total 12 conditions) were prepared. The dissolution test was performed with the ERWEKA DT 820, and a medium of distilled water. Sample of 5ml solution was drawn at 5 intervals until 120th minute. The experiment was repeated twice for each testing condition. The samples were processed through high performance liquid chromatography. A standard curve of stock solution with 2-fold serial dilution performed using methanol was obtained. Results: The results showed that the condition of level 0 liquid with an unopened capsule had the most ideal cumulative drug release profile. Among IDDSI levels, the profiles did not differ, which could be explained by opened capsule in all conditions involving thickened liquids. All conditions of thickened liquid and food as vehicle did not reach a drug release over 50% across all time intervals. Conclusion: This study confirmed that opened capsule affected medication dissolution. The clinical implication from this study was capsules should not be opened for consumption regardless of the liquid/food vehicle as it would affect the medication dissolution significantly.

Swallowing outcomes after surgical treatment for unilateral vocal cord immobility: a comparative analysis of injection laryngoplasty, medialisation thyroplasty, and unilateral non-selective laryngeal reinnervation

R. Balaji1, A. Haymes1, R. Travis2, K. Lammas1, S. Mouratidou1, S. Hey1, Y. Karagama1                                  doi: 10.48095/ccorl2025S1_36

1 Department of Otolaryngology and Head and Neck Surgery, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

2 GKT School of Medical Education, King’s College, London, UK

Background: Unilateral vocal cord immobility (UVCI) can impair swallowing, causing choking, coughing, throat hypersensitivity, aspiration, and recurrent chest infections. While surgical interventions for UVCI are primarily aimed at improving voice outcomes, swallowing-related complications due to glottal insufficiency can significantly impact quality of life and warrant equal consideration in clinical management. Aims: To evaluate swallowing and throat symptoms in UVCI patients following injection laryngoplasty (IL), medialisation thyroplasty (MT), or unilateral non-selective laryngeal reinnervation (UNSLR). Methods: Retrospective review of UVCI patients undergoing IL, MT, or UNSLR between January 2023 and May 2024 at a tertiary laryngology centre. Two outcome measures were used: the primary measure, EAT-10 score, to assess swallowing ability, while the secondary measure, RSI, reflects laryngopharyngeal symptoms. Both are evaluated preand post-procedure. A paired t-test was used to assess for statistical significance. Results: 56 patients (23 F : 33 M) were identified, 70% (40/56) underwent IL, 23% (13/56) MT, and 7% (3/56) UNSLR. By comparing preand postprocedure outcomes: In IL group (29/40 hyaluronic acid, 11/40 calcium hydroxyapatite): At 4 months, EAT-10 improved by 3.32 (Δ –1.08 to –5.56; P = 0.005), and RSI by 5.69 (Δ –3.11 to –8.26, P = 0.0001). In MT group (12/13 VOIS®, 1/13 silicone implant): At 10 months, EAT-10 improved by 7.42 (Δ –2.11 to –12.72; P = 0.01), and RSI by 8.23 (Δ –1.49 to –14.97; P = 0.02). In UNSLR group: At 10 months, EAT-10 improved by 6.50 (Δ +12.56 to –25.56; P = 0.1), and RSI by 11.33 (–0.99 to –21.68; P = 0.04). Conclusion: All three surgical treatments can significantly improve swallowing and throat symptoms in UVCI patients and should be routinely considered to optimise outcomes. Treatment choice should be guided by UVCI aetiology, surgical candidacy, and patient preference.

Oropharyngeal dysphagia in infants – a retrospective analysis from 2016–2022

V. Kranebitter1, M. Scharitzer2, I. Roesner3, D.-M. Denk-Linnert1                                                                                         doi: 10.48095/ccorl2025S1_37

1 Division of Phoniatrics and Speech Language Therapy, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria

2 Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

3 Private practice ORL and Phoniatrics, Pediatric Outpatient Center Schumanngasse, Vienna, Vienna, Austria

Introduction: The anatomy and physiology of the swallow are very complex. Mature born and healthy infants are equipped with all reflex paths necessary for a functioning suck-swallow-coordination. In the first months of life and early childhood swallowing abilities further develop and mature. The increasing survival in preterm infants and infants with complex anomalies or syndromes leads to a growing number of infants with swallowing disorders and the need for detailed investigation. Aim: The purpose of this study was to characterize our patient collective of infants aged 0–9 months having undergone further investigation for dysphagia. Materials and Methods: We retrospectively analyzed all consecutive patients aged 0–9 months who were examined at the Department of ENT/Phoniatrics at the Medical University of Vienna and also underwent a videofluoroscopic swallowing study in the years 2016–2022. Results: 65 infants were included in this study. 32/65 (49%) showed laryngeal pathologies, including laryngomalacia (N = 15), vocal fold paralysis (N = 7), subglottic stenosis (N = 3) and others. Comorbidities were present in 55/65. Videofluoroscopy identified aspiration in 19 out of 65 exams. The Penetration-aspiration scale (PAS) was distributed as follows: PAS 1 (31/65), PAS 2 (6/65), PAS 4 (5/65), PAS 5 (4/65) and PAS 8 (19/65). In infants with PAS 8, laryngeal pathologies were detected in 7/19 (37%). Detailed videofluoroscopic analysis showed malfunction in suck rhythm (N = 2), bolus formation (N = 8) and timing of the initiation of pharyngeal swallow (N = 23), leaking (N = 6), nasal regurgitation (N = 23) and residues (N = 12). Conclusion: A well-functioning act of swallowing is a prerequisite for thriving and developing. The understanding and identification of its impairment are of utmost importance. Interdisciplinary management, as well as an individual diagnostic and therapeutic approach, are essential.

The utility of the FEES in the early diagnosis of dysphagia and nutrition decisions in post-stroke patients

K. Piwowarczyk1, M. Leszczyńska2, M. Karlik1, B. Maciejewska1, S. Michalak3, J. Banaszewski2         doi: 10.48095/ccorl2025S1_38

1 Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznan, Poland

2 Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland

3 Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland

Introduction: Post-stroke dysphagia is one of the most frequent complications after cerebrovascular events, with aspiration pneumonia – stemming from swallowing difficulties – being a leading cause of mortality. Selecting appropriate nutrition for poststroke patients (PSPs) is thus vital during hospitalization. Fiberoptic endoscopic evaluation of swallowing (FEES) is a key tool for diagnosing dysphagia and guiding feeding strategies. This study investigated the prevalence and etiology of dysphagia in PSPs and evaluated FEES’s effectiveness in informing nutritional interventions to reduce complications. Material and Methods: A cross-sectional study was carried out in 29 adult PSPs admitted to the neurology unit of a tertiary care hospital. The FEES procedure involved sequential administration of three food bolus types – semisolid, liquid, and solid – and results were evaluated using Daniels’ test and the Penetration-aspiration scale (PAS). The relationship between FEES findings and length of hospitalization was also examined. Results: The mean age was 67 years (range 26–83). Facial nerve palsy was noted in five patients, and hypoglossal nerve palsy in two. Based on FEES findings, patients were divided into three groups: residue in the vallecula and/or pyriform sinus (N = 12; 41.38%; PAS 8), penetration only (N = 7; 24.14%; PAS 2–4), and penetration with aspiration (N = 10; 34.38%; PAS 5–8). FEES was performed on average 2–7 days post-stroke. Fifteen individuals were using a nasogastric tube (NGT) during examination and initiated feeding rehabilitation afterward. Following FEES, additional nutritional decisions were made: in five cases the NGT was removed, and three patients were referred for PEG placement. Conclusion/Discussion: FEES assessment is essential for guiding nutritional recommendations in PSPs. A key priority is establishing a standardized feeding algorithm for these individuals and raising awareness of the importance of collaboration between stroke unit teams, laryngologists, and phoniatricians.

R-CPD (retrograde cricopharyngeus dysfunction), where do we stand in 2025

J. A. Snelleman                                                                                                                                                    doi: 10.48095/ccorl2025S1_39

ENT, Meander Medisch Centrum, Amersfoort, the Netherlands

R-CPD or Retrograde cricopharyngeus dysfunction as a diagnosis is gaining ground, but still disputed. The clinical picture is fairly typical, the disease burden on patients very real and the results of a usually one-off dosis of botulinum toxin into the cricopharyngeus muscle remarkable. Do we need an objective technical diagnostic test? How do we deal with the growing number of patients who recognize their problem? EMG guided injection in the office seems to be an acceptable alternative to an injection during an esophagoscopy under general anesthesia. This presentation aims to give an overview and an update on this issue.

Spectrum of dysphagia in lateral medullary syndrome and its management

V. Vinayakumar, M. Elanjikkal Issac, J. R. Menon                                                                                      doi: 10.48095/ccorl2025S1_40 Laryngology, Ananthapuri Hospital and Research Institute, Thiruvananthapuram, India

Introduction: Lateral medullary syndrome (LMS) occurs due to vascular event in the dorsolateral side of medulla oblangota. More than half of the patients with Lateral medullary syndrome experience swallowing difficulty. FEES and VFSS evaluation are needed to assess the cause of dysphagia in this condition. Difficulty in swallowing is treated according to the pathophysiology of dysphagia. It requires compensatory as well as rehabilitatory swallowing therapy. In some instances, it may also require interventional swallowing therapy in the form of botox injection or cricopharyngeal myotomy. Aims: 1. To assess the spectrum of dysphagia in lateral medullary syndrome; 2. To assess the various modalities of treatment and recovery of dysphagia in patients admitted with lateral medullary syndrome. Materials and Methods: All patients with dysphagia due to lateral medullary syndrome from January 2021 to December 2023 were taken into the study. Demographic profile, side of the lesion and diabetic status of these patients were assessed. Clinical swallowing evaluation was done in them followed by FEES and fluoroscopic assessment and swallowing therapy for 6 weeks. If no recovery after 6 weeks, active intervention was done. Recovery of the patients was analyzedby assessing improvement in Functional oral intake scale. Results: Spontaneous recovery was seen in only 6 of the patients. Botox injection was given in 12 of the 13 patients who had complete cricopharyngeal dysmotility. Cricopharyngeal myotomy was done in 1 patient who had failed botox injection. Cricopharyngeal myectomy with hyoidopexy was done in another patient with failed botox injection who had absent hyolaryngeal elevation. Conclusion: Active intervention is done for dysphagia in LMS if there is no improvement in 6 weeks. Cricopharyngeal dysmotility was the most important cause of dysphagia in lateral medullary syndrome. Most patients could be resumed on oral feeds after giving botox injection in these patients.