Does epiglottic deflection contribute to airway protection in patients with dementia?

Abstract

A major consequence of dysphagia is aspiration, and epiglottic inversion is thought to help prevent aspiration by sealing off the airway during a normal swallow. The effects of aging and disease on the epiglottis have been minimally researched. The purpose of the current study was to examine epiglottic deflection and its relationship to airway protection in patients with dementia.

Through a retrospective analysis of videofluoroscopic swallow studies, the swallows of 44 subjects (mean age: 84; range: 46-100 years) were analyzed in duplicate by blinded raters. The raters judged epiglottic deflection using Component 10 (Epiglottic Movement) of the MBSImP, and airway invasion during the swallow using the Penetration-Aspiration Scale (PAS). Both epiglottic inversion and PAS scores were converted to binary variables in order to conduct Chi-square tests: PAS of 1 versus PAS of 2+, and complete versus incomplete epiglottic inversion.

Analyses revealed no significant differences in swallow safety based on epiglottic deflection in this population. Given the research suggesting epiglottic deflection is linked to hyoid movement and pharyngeal constriction, post-hoc analyses were conducted to determine if incomplete epiglottic deflection was the result of reduced hyoid movement using normative values published by Molfenter and Steele (2014) and/or reduced pharyngeal constriction. Analyses showed that epiglottic inversion had no relationship with peak hyoid displacement, nor was there a relationship with pharyngeal constriction in this population.

In conclusion, the current study suggests that the epiglottis does not play a vital role in airway protection in patients with dementia, and its deflection is unrelated to hyoid displacement and pharyngeal constriction in this population. Future research should investigate the physiological impairments causing penetration and aspiration in this population, as well as the kinematics related to epiglottic deflection.