Upper Esophageal Sphincter Response to Laryngeal Adductor Reflex Elicitation in Humans
Objective The laryngeal adductor reflex (LAR) is an important mechanism to secure the airways from potential foreign body aspiration. An involvement of the upper esophageal sphincter (UES) in terms of a laryngo‐UES contractile reflex has been identified after laryngeal mucosa stimulation. However, t...
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Published in | The Laryngoscope Vol. 131; no. 6; pp. E1778 - E1784 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.06.2021
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Subjects | |
Online Access | Get full text |
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Summary: | Objective
The laryngeal adductor reflex (LAR) is an important mechanism to secure the airways from potential foreign body aspiration. An involvement of the upper esophageal sphincter (UES) in terms of a laryngo‐UES contractile reflex has been identified after laryngeal mucosa stimulation. However, the LAR–UES relationship has not yet been fully explained. This study aimed to determine the magnitude, latency, and occurrence rate of the UES pressure response when the LAR is triggered in order to elucidate the functional relationship between the larynx and the UES.
Methods
This prospective study included seven healthy volunteers (5 female, 2 male, age 22–34 years). Laryngeal penetration was simulated by eliciting the LAR 20 times in each individual by applying water‐based microdroplets onto the laryngeal mucosa. UES pressures were measured simultaneously using high‐resolution manometry.
Results
Two distinct pressure phases (P1, P2) associated with the LAR were identified. P1 corresponded with a short‐term UES pressure decrease in two subjects and a pressure increase in five subjects occurring 200 to 500 ms after the stimulus. In P2, all subjects experienced an increase in UES pressure with a latency time of approximately 800 to 1700 ms and an average of 40 to 90 mmHg above the UES resting tone.
Conclusion
Foreign bodies penetrating the laryngeal inlet lead to a reflex contraction of the UES. Phase P1 could be a result of vocal fold activity caused by the LAR, leading to pressure changes in the UES. The constriction during P2 could strengthen the barrier function of the UES in preparation to a subsequent cough that may be triggered to clear the airways.
Level of Evidence
4 Laryngoscope, 131:E1778–E1784, 2021 |
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Bibliography: | These authors contributed equally to this work. Parts of this project were funded by Deutsche Forschungsgemein‐schaft, grants PT 2/5‐1 and KA 2975/6‐1. j.f.f and Editor's Note: This Manuscript was accepted for publication on September 18, 2020 filed patents related to MIT‐LAR that are currently under review. These two authors therefore declare a potential conflict of interest. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Presented at the 36th annual conference of the “Deutsche Gesellschaft für Phoniatrie und Pädaudiologie” (DGPP, German Society of Phoniatrics and Pediatric Audiology), Göttingen, Germany, September 22, 2019. m.p |
ISSN: | 0023-852X 1531-4995 |
DOI: | 10.1002/lary.29166 |