Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: Feasible and correlative

Laryngopharyngeal sensory testing can predict aspiration risk in adult pati ents. Its feasibility and potential role in the evaluation of pediatric swa llowing is undetermined. The goals of this study were to determine the feas ibility of performing laryngopharyngeal sensory testing in awake pediatric patients and to assess whether the sensory testing results correlated with aspiration during a feeding assessment or correlated with a history of pneu monia. Fiberoptic endoscopic evaluation of swallowing with sensory testing was performed in 100 pediatric patients who were evaluated for feeding and swallowing disorders. The swallowing function parameters evaluated were poo led secretions, laryngeal penetration, and aspiration. The laryngopharyngea l sensory tests were performed by delivering a pressure-controlled and dura tion-controlled air pulse to the aryepiglottic fold through a flexible lary ngoscope to induce the laryngeal adductor response (LAR). The air pulse sti mulus ranged in intensity from 3 to 10 mm Hg. The patients tested ranged fr om 1 month to 24 years of age, with a median age of 2.7 years. Sensory test ing was completed in 92% of patients. Patients who had an LAR at less than 4 mm Hg rarely if ever had episodes of laryngeal penetration or aspiration. Those with an LAR at 4 to 10 mm Hg had variable amounts of aspiration and laryngeal penetration. The LAR could not be elicited at the maximum level o f intensity (10 mm Hg) in 22 patients, who demonstrated severe laryngeal pe netration and/or aspiration. Elevated laryngopharyngeal sensory thresholds correlated positively with previous clinical diagnoses of recurrent pneumon ia, neurologic disorders, and gastroesophageal reflux, and correlated posit ively with findings of pooled secretions, laryngeal penetration, and aspira tion. Laryngopharyngeal sensory testing in children is feasible and correla tive.