Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients
- •Vocal fold motion impairment and silent aspiration is seen in patients referred for instrumental assessment following cardiothoracic surgery.
- •Some patients require longer periods of tube feeding and surgical interventions for persistent vocal fold motion impairment.
- •Early endoscopic assessment may allow early management and prevention of secondary complications.
Cardiothoracic surgery is known to result in dysphagia and laryngeal injury. While prevalence has been explored, extent, trajectory and longevity of symptoms are poorly understood. This retrospective, observational study explored dysphagia and laryngeal injury in patients following cardiothoracic surgery referred for instrumental swallowing assessment.
Clinical notes and endoscopic recordings of 106 patients (age range 18–87 yrs; mean 63 yrs; SD 15 yrs) (including 190 endoscopes) at one large tertiary centre were reviewed by two speech-language pathologists and a laryngologist. Standardized measures of laryngeal anatomy and physiology, New Zealand Secretion Scale, Penetration-Aspiration scale and Yale Residue Scale were rated.
Prevalence of abnormality included 39% silent aspiration, 65% laryngeal edema and 61% vocal paralysis. The incidence of pneumonia was 36% with a post-operative stroke rate of 14%. Forty percent of patients were receiving a standard diet by discharge from acute care; while, 24% continued to require enteral feeding and 8% received laryngeal surgery within twelve months of discharge. Vocal fold motion impairment was significantly associated with ventilation time and tracheostomy tube duration (p < .05).
Early endoscopic assessment for identification of dysphagia and laryngeal injury in patients following cardiothoracic surgery may allow early management and prevention of secondary complications.
J Crit Care. 2018 Feb 9;45:121-127. doi: 10.1016/j.jcrc.2018.01.027. [Epub ahead of print]