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Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report.
Medicine (Baltimore). 2020 Feb; 99(7):e19220.M

Abstract

INTRODUCTION

Injection laryngoplasty is a common procedure for patients with vocal fold dysfunction, but the literature on its benefits has been mainly focused on those related to structural lesions or laryngeal nerve involvement. Stroke patients may be at increased risk of aspiration due to insufficient vocal fold motion. However, how injection laryngoplasty can be of benefit in stroke patients has not been reported yet.

PATIENT CONCERNS

Six chronic stroke patients with long-standing swallowing difficulties and who showed severe aspiration despite long-term swallowing rehabilitation.

DIAGNOSIS

Laryngoscope evaluation revealed insufficient glottic closure as the cause of aspiration.

INTERVENTIONS

Injection laryngoplasty was done per-orally under local anaesthesia with calcium hydroxylapatite (Radiesse Voice, 1-1.5 mL) in an office setting. Respiratory pressures and peak cough flows were assessed at baseline and at 2 weeks follow-up.

OUTCOMES

At 2 weeks, the mean peak cough flow (Δ = +95.09 L/min) increased significantly after the procedure. The maximal expiratory (Δ = +18.40 cm H2O) and inspiratory (Δ = +20.20 cm H2O) pressures also improved, indicating that injection laryngoplasty was effective in augmenting respiratory and cough parameters. All cases showed improvement in the Functional Oral Intake Scale (Δ = +4). Feeding tubes were successfully removed.

CONCLUSION

Injection laryngoplasty proved to be both successful and safe in improving glottic closure with immediate results in those who had failed to show a positive response after long-term swallowing rehabilitation. The positive and dramatic clinical outcomes were observed through changes in the coughing force. Our case series support the use of injection larygnoplasty as a powerful adjunctive treatment method to prevent aspiration pneumonia in post-stroke patients with vocal fold insufficiency. Pre- and post-injection peak cough flow changes may reflect improvement in glottic closure and indicate the safety of swallowing with reduced risk of aspiration.

Authors+Show Affiliations

Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine.Department of Rehabilitation Medicine, Graduate School.Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine.Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32049860

Citation

Han, Yeon Jae, et al. "Role of Injection Laryngoplasty in Preventing Post-stroke Aspiration Pneumonia, Case Series Report." Medicine, vol. 99, no. 7, 2020, pp. e19220.
Han YJ, Jang YJ, Park GY, et al. Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report. Medicine (Baltimore). 2020;99(7):e19220.
Han, Y. J., Jang, Y. J., Park, G. Y., Joo, Y. H., & Im, S. (2020). Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report. Medicine, 99(7), e19220. https://doi.org/10.1097/MD.0000000000019220
Han YJ, et al. Role of Injection Laryngoplasty in Preventing Post-stroke Aspiration Pneumonia, Case Series Report. Medicine (Baltimore). 2020;99(7):e19220. PubMed PMID: 32049860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report. AU - Han,Yeon Jae, AU - Jang,Yong Jun, AU - Park,Geun-Young, AU - Joo,Young Hoon, AU - Im,Sun, PY - 2020/2/13/entrez PY - 2020/2/13/pubmed PY - 2020/2/23/medline SP - e19220 EP - e19220 JF - Medicine JO - Medicine (Baltimore) VL - 99 IS - 7 N2 - INTRODUCTION: Injection laryngoplasty is a common procedure for patients with vocal fold dysfunction, but the literature on its benefits has been mainly focused on those related to structural lesions or laryngeal nerve involvement. Stroke patients may be at increased risk of aspiration due to insufficient vocal fold motion. However, how injection laryngoplasty can be of benefit in stroke patients has not been reported yet. PATIENT CONCERNS: Six chronic stroke patients with long-standing swallowing difficulties and who showed severe aspiration despite long-term swallowing rehabilitation. DIAGNOSIS: Laryngoscope evaluation revealed insufficient glottic closure as the cause of aspiration. INTERVENTIONS: Injection laryngoplasty was done per-orally under local anaesthesia with calcium hydroxylapatite (Radiesse Voice, 1-1.5 mL) in an office setting. Respiratory pressures and peak cough flows were assessed at baseline and at 2 weeks follow-up. OUTCOMES: At 2 weeks, the mean peak cough flow (Δ = +95.09 L/min) increased significantly after the procedure. The maximal expiratory (Δ = +18.40 cm H2O) and inspiratory (Δ = +20.20 cm H2O) pressures also improved, indicating that injection laryngoplasty was effective in augmenting respiratory and cough parameters. All cases showed improvement in the Functional Oral Intake Scale (Δ = +4). Feeding tubes were successfully removed. CONCLUSION: Injection laryngoplasty proved to be both successful and safe in improving glottic closure with immediate results in those who had failed to show a positive response after long-term swallowing rehabilitation. The positive and dramatic clinical outcomes were observed through changes in the coughing force. Our case series support the use of injection larygnoplasty as a powerful adjunctive treatment method to prevent aspiration pneumonia in post-stroke patients with vocal fold insufficiency. Pre- and post-injection peak cough flow changes may reflect improvement in glottic closure and indicate the safety of swallowing with reduced risk of aspiration. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/32049860/Role_of_injection_laryngoplasty_in_preventing_post-stroke_aspiration_pneumonia,_case_series_report L2 - http://dx.doi.org/10.1097/MD.0000000000019220 DB - PRIME DP - Unbound Medicine ER -