Temporal Sequence of Laryngeal Vestibule Closure and Reopening is Associated With Airway Protection

Abstract

Background: Upper esophageal sphincter opening (UESO), and laryngeal vestibule closure (LVC) are two essential kinematic events whose timings are crucial for adequate bolus clearance and airway protection during swallowing. Their temporal characteristics can be quantified through time-consuming analysis of videofluoroscopic swallow studies (VFSS).

Objectives: We sought to establish a model to predict the odds of penetration or aspiration during swallowing based on 15 temporal factors of UES and laryngeal vestibule kinematics.

Methods: Manual temporal measurements and ratings of penetration and aspiration were conducted on a videofluoroscopic dataset of 408 swallows from 99 patients. A generalized estimating equation model was deployed to analyze association between individual factors and the risk of penetration or aspiration.

Results: The results indicated that the latencies of laryngeal vestibular events and the time lapse between UESO onset and LVC were highly related to penetration or aspiration. The predictive model incorporating patient demographics and bolus presentation showed that delayed LVC by 0.1 s or delayed LVO by 1% of the swallow duration (average 0.018 s) was associated with a 17.19% and 2.68% increase in odds of airway invasion, respectively.

Conclusion: This predictive model provides insight into kinematic factors that underscore the interaction between the intricate timing of laryngeal kinematics and airway protection. Recent investigation in automatic noninvasive or videofluoroscopic detection of laryngeal kinematics would provide clinicians access to objective measurements not commonly quantified in VFSS. Consequently, the temporal and sequential understanding of these kinematics may interpret such measurements to an estimation of the risk of aspiration or penetration which would give rise to rapid computer-assisted dysphagia diagnosis.

Level of evidence: 2 Laryngoscope, 133:521-527, 2023.

Keywords: aspiration; dysphagia; laryngeal vestibule closure; upper esophageal sphincter; videofluoroscopic swallow studies.

FIGURE 1.

Upper esophageal sphincter opening (UESO), and laryngeal vestibule closure (LVC) events occur in sequential manner based on videofluoroscopic analysis.