Laryngeal and swallowing characteristics in elderly after stroke: a preliminary study

Purpose To carry out a comparative analysis between the aspects of safety (penetration/aspiration) and efficiency (residues) of swallowing with the morphological characteristics and phonatory functional behavior of the larynx, in elderly after stroke, in the late phase. Methods Observational and retrospective study carried out based on the analysis of recordings of Fiberoptic Endoscopic Evaluation of Swallowing and Laryngoscopy examinations of speech and swallowing in 24 patients. The following were considered: laryngeal asymmetry, arching of the membranous portion, increased volume of the vestibular folds, classification of glottic closure, presence of median and anteroposterior constriction during phonation. For swallowing, the Penetration and Aspiration scales, the Yale Pharyngeal Residue Severity Rating Scale to classify residues in valleculae and pyriform sinuses, and the pharyngeal residue scale proposed by Kelly et al. (2006) were used. The Mann-Whitney and Kruskal-Wallis tests were applied, considering a significance level of 5%. Results Most patients presented arching of the membranous portion of the vocal folds and increased volume of the vestibular folds, as well as anteroposterior constriction of the arytenoids. Laryngeal penetration, presence of residues in valleculae, pyriform sinuses and pharynx were identified for IDDSI 0 and 4 consistencies, and aspiration with IDDSI 0. At IDDSI level 0, the presence of anteroposterior constriction of the arytenoids during phonation was associated with lower scores on the Penetration-Aspiration Scale (p=0.016) and the Pharyngeal Residue Scale (p=0.013). Lower scores on the residual scale in valleculas were observed according to the amount of epiglottis coverage (p=0.017) for IDDSI 4. Furthermore, the absence of vocal fold asymmetry was associated with lower pharyngeal residue scores (p=0.025) and vallecular residue scores (p=0.008) for IDDSI level 7. Conclusion Swallowing safety and efficiency differ in individuals with late post-stroke presenting anteroposterior constriction, and swallowing efficiency also varies according to the degree of epiglottic coverage and vocal fold symmetry in these individuals.