Predictive value of laryngeal adductor reflex testing in patients with dysphagia due to a cerebral vascular accident.

PURPOSE: To determine the relationship between air pulse vs. touch laryngeal adductor reflex (LAR) tests and the clinical sensory findings of fiberoptic endoscopic evaluations of swallowing.

METHOD: A retrospective review was conducted for 43 patients with dysphagia due to stroke that underwent fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). Each patient received LAR testing using air pulse or touch methodologies. Clinically, responsiveness to pharyngeal residue and responsiveness to penetration or aspiration were analysed.

RESULT: The sensitivity, specificity, positive and negative predictive values for both LAR test groups indicate that LAR testing did not effectively predict sensory function during the clinical swallow evaluation. Across both LAR groups, specificity values were higher than sensitivity values. In fact, the specificity values for the light touch LAR test group were extremely high, but the negative predictive values did not support those findings. Sensitivity and positive predictive values were low for both groups.

CONCLUSION: Although LAR testing provides valuable information regarding laryngeal sensory discrimination, the results of the current study suggest that a clinical evaluation of swallowing is critical for effectively assessing the way in which patients utilise sensory information during swallowing.