Laryngeal Sarcoidosis and Swallowing: What Do We Know About Dysphagia Assessment and Management in this Population?
Lindsay Lovell, Gemma M Clunie, Chadwan Al-Yaghchi and 2 others
PMID 34037851WHAT IT FOUND
Seven patients with laryngeal sarcoidosis showed silent aspiration on instrumental tests despite normal eating scores.
Bedside checks missed these safety risks. Specialists recommend instrumental assessment for this group to catch airway threats that patients cannot feel.
Key findings
01Instrumental assessment revealed that six of seven patients had penetration or aspiration scores between 3 and 8, while all maintained a Functional Oral Intake Scale score of 5 to 7, indicating they could eat a full oral diet.
02All seven patients were either insensate to material entering their airway or had an inconsistent cough response, meaning they were unaware of the extent of their swallowing difficulties.
03Partial or minimal epiglottic deflection was a common theme across all patients and appears to be the main reason for the observed penetration and aspiration.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is a retrospective case series of only seven patients, which limits the generalisability of the findings. Patients were referred to speech therapy only if they mentioned swallowing difficulties or if surgeons requested a baseline, so those with silent dysphagia who did not report symptoms may have been missed. A mix of videofluoroscopy and fibreoptic endoscopic evaluation was used, which may affect the consistency of scoring. The size and amount of food boluses varied by patient rather than being standardised. The study design cannot prove that specific speech therapy exercises caused the improvements seen, as some patients improved after surgery alone or had fluctuating disease.
Declared interests
The authors declare no conflicts of interest. The study was supported by non-US government funding.
The easy way to misread this
Do not assume that a patient with laryngeal sarcoidosis is safe to eat simply because they are on a normal diet and do not report coughing or choking. The study shows that all seven patients had a normal diet score, yet six had penetration or aspiration on instrumental testing, and none were reliably aware of these events.