Purpose: The purpose of this study was to evaluate the presence of aspiration-penetration in patients with unilateral vocal cord paralysis, and to examine the correlation between the findings of the Gugging Swallowing Screen (GUSS), which is a subjective evaluation method, and the Fiberoptic Endoscopic Swallowing Study (FEES), which is objective. Method: Correlational research model was used in this study. 8 patients with unilateral vocal cord paralysis who were seen at the ear nose throat clinic of İstanbul Samatya Education Research Hospital within a 6-month period in 2018 and the beginning of 2019 were included in this study. 4 of the 8 patients (50%) were female and 4 (50%) were male. In 4 patients (%50), the paralysis was seen in the right vocal cord and in the other 4 patients (%50), in the left vocal cord. The cause of paralysis in 4 of 8 patients (%50) was thyroidectomy, in 3 (%37,5), it was idiopathic and in 1 (%12,5) patient, it was seen following pneumonectomy. After filling out an information form with the medical history and complaints of the patients, GUSS was administered by a speech and language therapist and FEES was implemented by an ear nose throat doctor. Results: 6 (75%) of the 8 patients were diagnosed with the presence of aspiration-penetration using GUSS, and 4 (%50) were diagnosed to have aspiration-penetration using FEES. There was a weak and statistically non-significant negative correlation between the FEES scores and the GUSS scores (r=-0.247; p=0.555). Conclusion: In patients with unilateral VCP, as a result of the vocal cords being immobilized due to paralysis, airway protection may deteriorate. The GUSS and FEES assessments performed in this study showed that a large majority of patients with VCP demonstrated signs of aspiration and/or penetration. Assessment with GUSS resulted in identifying more cases as having aspiration-penetration than FEES. 4 of 6 patients who were diagnosed to have aspiration-penetration with the GUSS evaluation were also found to have aspiration-penetration following objective evaluation, FEES. The other two were possibly false positives. False positives are likely to urge patients and therapists to be more cautious in therapy. Therefore, it can be concluded that GUSS can be used as an alternative measurement tool in clinical conditions and can give an idea of aspiration presence in patients with unilateral VCP, in cases where an objective assessment of aspiration is not possible. These results are in line with the literature findings. The weak insignificant correlation found was possibly due to the small number of patients in this study. For further confirmation, it is recommended that the study be repeated with a larger number of patients.
Keywords
dysphagia, swallowing disorder, vocal cord paralysis, aspiration, penetration
References
American Speech-Language & Hearing Association (2019). Swallowing disorders in adults. Erişim adresi: https://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/
Akçi̇l, M. (2015). Pnömoni öyküsü olan yaşlılarda yutma fonksiyonunun değerlendirilmesi. Yayınlanmamış Yüksek Lisans Tezi. Hacettepe Üniversitesi, Sağlık Bilimleri Enstitüsü, Ankara.
Aviv, J. E., Kim, T., Thomson, J. E., Sunshine, S., Kaplan, S., & Close, L. G. (1998). Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls. Dysphagia, 13(2), 87–92. doi:10.1007/PL00009561
Bhattacharyya, N., Kotz, T., & Shapiro, J. (2002). Dysphagia and aspiration with unilateral vocal cord immobility: Incidence, characterization, and response to surgical treatment. Annals of Otology, Rhinology & Laryngology, 111(8), 672–679. doi:10.1177/000348940211100803
Boeschi R., & Deboer, M. (2019). Aspiration. R. Wilmott, A. Bush, R. Deterding, F. Ratjden, P. Sly, & H. J. Zar (Ed.), Kendig's Disorders of The Respiratory Tract in Children (9. baskı) içinde (s. 1097-1105). doi:10.1016/C2015-0-01292-8
Brady, S., & Donzelli̇, J. (2013). The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngologic Clinics of North America, 46(6), 1009–1022. doi:10.1016/j.otc.2013.08.001
Carruthers, D. G. (2013). Paralysis of The Vocal Cords. D. G. Carruthers (Ed.), Diseases of the Ear, Nose, and Throat (2. baskı) içinde (s. 295-302). Butterworth-Heinemann.
Counter, P. R., & Ong, J. H. (2018). Disorders of swallowing. Surgery (Oxford), 36(10), 535-542. doi:10.1016/j.mpsur.2018.08.004
Gerek, M., Çiyiltepe, M., Atalay, A. & Özkaptan, Y. (2004). Yutma bozukluğunda fiberoptik endoskopik tanı yöntemi ve değerlendirme protokolü. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi, 12(1): 25-42.
Heitmiller, R. F., Tseng, E., & Jones, B. (2000). Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment. Dysphagia, 15(4), 184–187. doi:10.1007/s004550000026
Irace, A.L., Dombrowski, N.D., Kawai, K., Dodrill, P., Perez, J., Hernandez, K., Davidson, K., Hseu, A., Nuss, R., & Rahbar, R. (2019). Aspiration in children with unilateral vocal fold paralysis. Laryngoscope, 129(3), 569-573. doi:10.1002/lary.27410
Jackson, S., & Eastaugh-Wari̇ng, T. (2018). Regurgitation and aspiration. Anaesthesia & Intensive Care Medicine, 19(9), 471–474. doi:10.1016/j.mpaic.2018.06.004
Jafari̇, S., Pri̇nce, R. A., Ki̇m, D. Y., & Paydarfar, D. (2003). Sensory regulation of swallowing and airway protection: A role for the internal superior laryngeal nerve in humans. The Journal of Physiology, 550(1), 287–304. doi:10.1113/jphysiol.2003.039966
Jang, Y. Y., Lee, S. J., Jeon, J. Y., & Lee, S. J. (2011). Analysis of video fluoroscopic swallowing study in patients with vocal cord paralysis. Dysphagia, 27(2), 185–190. doi:10.1007/s00455-011-9351-3
Karaduman, A., Serel, S., Ünlüer, Ö., & Demi̇r, N. (2012). Penetrasyon aspirasyon skalası: Kişiler arası güvenirlik çalışması. Fizyoterapi Rehabilitasyon, 23(3), 151-155. Erişim adresi: https://dergipark.org.tr/tr/download/article-file/138070