Assessment of the effectiveness of laryngeal protection mechanisms in patients with iatrogenic, unilateral laryngeal paralysis

Introduction: Postoperative paresis of the laryngeal nerves may disrupt the protection function of the larynx during swallowing. Material and method: Stage 1: Retrospective analysis of FEES reports in patients with unilateral laryngeal paralysis (n = 99) in terms of the occurrence of penetration or aspiration of saliva and liquid and solid food. Stage 2: Prospective analysis of the results of the EAT-10 screening questionnaire and reports (n = 12) of FEES examination performed in the early postoperative period (up to 7 days after the surgery) in patients with iatrogenic palsy of the X cranial nerve. Assessment of: sensory of the larynx, effectiveness for cough and pressure tests, presence of "white out", PAS scale for a regular diet according to IDDSI (ST 0; ST 7). Results: Stage 1: Penetration or aspiration was found in 65% of patients, in 29% of patients it were silent symptoms. Salivary penetration or aspiration concerned 60.60% of patients. Among people who developed silent disorders, 20 had isolated n. X paralysis, and 79% - polyneuric palsy. The PAS level between 2-8 was found in 65% of patients. Stage 2: 11/12 patients obtained the result of the EAT 10 questionnaire > = 3. "White out" elongation and sensory loss were found in 75% of patients, ineffective cough in 33%. In oral trials, residue (50% ST0), premature swallowing (8% ST0), penetration (33% ST0, 8% ST7) and aspiration (16% ST0, 8% ST7) were found. Adaptive and compensatory techniques were the most frequently combined (66%), and the dominant technique was turning the head towards the affected side. Conclusions: In every sixth patient with iatrogenic laryngeal paralysis, aspiration of non-condensed fluids occurs early after the surgery, and the penetration of these contents into the larynx occurs in every third patient. It is therefore advisable to improve the comfort associated with the quality of life dependent on swallowing and to prevent complications of dysphagia in the study group. Therefore, it is justified to extend diagnostics to include clinical assessment of swallowing and qualify patients for FEES assessment. Key words: dysphagia, penetration, aspiration, laryngeal paralysis, FEES, vocal fold paresis, oropharyngeal dysphagia