ROLE OF FLEXIBLE LARYNGOSCOPY IN EVALUATING ASPIRATION

Flexible fiberoptic laryngoscopy is used to evaluate dysphagia, but it s clinical utility has not been compared to that of the videofluorogra phic swallowing study (VFSS). This study correlates parameters of both procedures and identifies laryngoscopic predictors of aspiration in 1 05 patients. Presence of aspiration, pharyngeal residue, laryngeal sen sation, vocal cord mobility, and glottic closure during flexible laryn goscopy (FL), and gag reflex were correlated with aspiration during th e VFSS. An algorithm for laryngoscopically detecting aspiration was sy nthesized. Aspiration (p = .004) and pharyngeal residue (p < .00001) w ere highly correlated between the two studies. Aspiration during the V FSS was correlated with pharyngeal residue (p < .00001) and laryngeal sensation (p = .027) during FL, but not glottic closure (p = .169) nor vocal cord mobility (p = .056). Patients with a normal gag reflex and without aspiration or pharyngeal residue during FL had a 2.94% risk o f aspiration during the VFSS. Flexible laryngoscopy can be used as a r elatively safe, portable screening test for aspiration, but cannot alw ays replace the VFSS to identify the presence or cause of aspiration.