Patterns of swallowing failure following medialization in unilateral vocal fold immobility

Objective. To quantify the incidence of penetration and aspiration following medialization for unilateral vocal cord immobility (UVCI) and determine patterns of failure. Study Design: Blinded analysis consecutive case series. Methods: Prospective blinded analysis of videofluoroscopic swallowing studies of patients who had received a medialization procedure was conducted, determining the incidence of penetration and aspiration by using the Penetration-Aspiration Scale. Pharyngeal transport measures were also assessed. Associations between clinical factors and penetration-aspiration were statistically determined. Results: Sixty-seven videofluoroscopic swallowing studies were reviewed in patients (mean age, 63.3 y) who had undergone vocal fold medialization (14 laryngoplasties and 53 vocal cord injections) for UVCI. Unilateral vocal cord immobility was left-sided in 56 patients (83.6%), and 50 patients (74.6%) had a postsurgical etiologic factor for their immobility. Thirty (44.8%) and 16 (23.9%) patients demonstrated penetration and aspiration, respectively. Penetration most often occurred during the swallow, but aspiration was equally likely to occur during or after the swallow. No differences in the incidence of penetration or aspiration were noted according to the side of vocal fold paralysis (P = .20, chi(2) test) or etiologic factor (P = .69). Further analysis found that swallow factors significantly associated with penetration and aspiration were swallow delay (P = .001, Wilcoxon ranked pairs test) and reduced laryngeal elevation (P = .001), as well as bolus residues in the valleculae (P = .002), piriform sinus (P = .001), or posterior pharynx (P = .008). Conclusions. Many patients demonstrate significant radiographic aspiration even after medialization procedures for UVCI. Although glottal incompetence is a known risk factor for aspiration, other factors including pharyngeal bolus transport are important in determining an effective swallow in UVCI.