Protection and regeneration of esophageal, pharyngeal, and laryngeal mucosa as a major element in therapy of patients with esophageal and extraesophageal reflux symptoms.

Treatment of esophageal and extraesophageal reflux syndromes is mainly focused on inhibiting the secretion of hydrochloric acid. In spite of the high efficacy of proton pump inhibitors, approx. 30-60% of GERD patients experience daily symptoms. Beside acid reflux, other factors such as abnormal esophageal peristalsis, visceral hypersensitivity, ineffective esophageal clearance mechanisms, and impaired mucosal barrier also play an important role in generating GERD symptoms. An additional therapeutic proposition is a procedure aimed at improving the defense mechanisms of esophageal mucosa rather than inhibiting the damage-inducing factors. The preparation consisting of hyaluronic acid (HA), chondroitin sulfate (SC) and poloxamer 407 protects against harmful factors (hydrochloric acid, pepsin) and accelerates mucosal healing and regeneration, constituting a substantial element of monotherapy or add-on therapy in patients with gastroesophageal reflux disease.

Visual and Automatic Evaluation of Vocal Fold Mucosal Waves Through Sharpness of Lateral Peaks in High-Speed Videokymographic Images.

INTRODUCTION: The sharpness of lateral peaks is a visually helpful clinical feature in high-speed videokymographic (VKG) images indicating vertical phase differences and mucosal waves on the vibrating vocal folds and giving insights into the health and pliability of vocal fold mucosa. This study aims at investigating parameters that can be helpful in objectively quantifying the lateral peak sharpness from the VKG images. METHOD: Forty-five clinical VKG images with different degrees of sharpness of lateral peaks were independently evaluated visually by three raters. The ratings were compared to parameters obtained by automatic image analysis of the vocal fold contours: Open Time Percentage Quotients (OTQ) and Plateau Quotients (PQ). The OTQ parameters were derived as fractions of the period during which the vocal fold displacement exceeds a predetermined percentage of the vibratory amplitude. The PQ parameters were derived similarly but as a fraction of the open phase instead of a period. RESULTS: The best correspondence between the visual ratings and the automatically derived quotients were found for the OTQ and PQ parameters derived at 95% and 80% of the amplitude, named OTQ95, PQ95, OTQ80 and PQ80. Their Spearman's rank correlation coefficients were in the range of 0.73 to 0.77 (P < 0.001) indicating strong relationships with the visual ratings. The strengths of these correlations were similar to those found from inter-rater comparisons of visual evaluations of peak sharpness. CONCLUSION: The Open time percentage and Plateau quotients at 95% and 80% of the amplitude stood out as the possible candidates for capturing the sharpness of the lateral peaks with their reliability comparable to that of visual ratings.

Ovine Vocal Fold Tissue Fatigue Response to Accumulated, Large-Amplitude Vibration Exposure at Phonatory Frequencies.

Purpose The contribution of tissue mechanical response to vocal fatigue is poorly understood. This study investigated the fatigue response of vocal fold tissues to large-amplitude vibration exposure at phonatory frequencies, using an ex vivo ovine model. Method Twelve sheep vocal fold mucosal specimens were subjected to sinusoidal, simple-shear deformation for prolonged cycles, under a large but physiological shear strain (46%) in a frequency range of 100-230 Hz. The duration of shear varied from a critical vibration exposure limit of 1,040 s to 4 times the limit (4,160 s). Tissue viscoelastic response was quantified by the elastic shear modulus (G'), viscous shear modulus (G″), and damping ratio (G″/G'). Results Distinct response patterns were observed at different frequencies. G' and G″ generally decreased with vibration exposure at 100 Hz, whereas they generally increased with vibration exposure at 200 and 230 Hz. Statistically significant differences were found for G″ increasing with vibration exposure at 200 Hz and damping ratio decreasing with vibration exposure at 200 Hz. Significant increases with frequency were also found for all viscoelastic functions. Results suggested that the contribution of tissue viscoelastic response to vocal fatigue could be highly frequency dependent. In particular, increases in G″ with vibration exposure could lead to high phonation threshold pressures and difficulty sustaining phonation at higher frequencies following prolonged vocalization. Conclusion These preliminary findings may help us better understand vocal fatigue and recovery and should be corroborated by studies with human vocal fold tissues.

Sulcus Vocalis.

Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic mucosal wave. The primary symptom is breathy, effortful dysphonia. Diagnosis may be challenging, and this classically has led to difficulties with identification and management. Treatment options, although often promising, have been notoriously unreliable. Current understanding, considerations for management, and future treatment options are explored.

Objective measurement of mucosal wave parameters in diagnosing benign lesions of the vocal folds.

INTRODUCTION: The diagnostic procedure of phonation is dominated by subjective assessment tools. It seems reasonable to seek methods of quantitative glottal cycle assessment. OBJECTIVE: The aim of our study was the analysis of open quotients (OQ) of the glottis. METHODS: One hundred and twenty-four people were included in the study. Methodology was based on tools available in everyday phoniatrics practice - laryngovideostroboscopy (LVS) and electroglottography (EGG). There were statistically significant differences between control and studied group. Vocal fold polyps, nodules and edema influence glottal function in a different manner, what can be illustrated by objective glottal function parameters. Establishing Videostroboscopic Open Quotient values from three parts of glottis and Electroglottographic Quasi Open Quotient (QOQ) value, can help in dividing patients with benign lesions of vocal folds according to the type of disease. RESULTS AND CONCLUSIONS: Measurement of the open quotient from three parts of the glottis helps to differentially diagnose and localize glottal vocal fold lesions. Videostroboscopic Open Quotient and Electroglottographic QOQ values can be used to quantify the glottal cycle. Videostroboscopic Open Quotient, Electroglottographic QOQ and their ratio varies depending on the type of organic dysphonia.

Improved Mucosal Wave in Unilateral Autologous Temporal Fascia Graft in Sulcus Vocalis Type 2 and Vocal Scars.

OBJECTIVES/HYPOTHESIS: We analyzed the results of 10 patients treated by unilateral autologous temporal fascia graft, comparing the pre and post surgery results, as well as the appearance of the wave and the intervals until the re-appearance of it. STUDY DESIGN: Retrospective, clinical case series. METHODS: Subjective and objective evaluation was preoperatively and postoperatively performed, using laryngovideostroboscopy, the Voice Handicap Index-10, GRBAS (grade, roughness, breathiness, asthenia, and strain), harmonics to noise ratio, Jitter, Shimmer, phonatory range, maximum phonation time, and S/Z ratio in all patients. Postoperative visits were scheduled after 1 week, 1 month, at 3 months, and at 6 months after the surgery. RESULTS: After surgery, we found significant differences in the maximum phonation time and the S/Z ratio (P <0.05). Most parameters of GRBAS also improved significantly, both in general and in the subscales, except for Breathiness and Asthenia (P <0.05). There was an average decrease in Voice Handicap Index-10 of 11.2 (P <0.05). At laryngovideostroboscopy, the mucous wave reappeared in all patients treated 1 month after surgery, and increased in amplitude until 6 months postoperative.

Proposal of a form for the collection of videolaryngostroboscopy basic findings.

Videolaryngostroboscopy is a useful investigation required for a correct diagnosis of laryngeal diseases and voice disorders. We present a form for the collection of basic laryngostroboscopic findings, which provides for the evaluation of the classical six parameters codified by Hirano (symmetry and periodicity of glottic vibration, glottic closure, profile of vocal fold edge, amplitude of vocal fold vibration, mucosal wave) and six other parameters which we have included in the form for an essential and complete laryngostroboscopic evaluation (supraglottic framework behaviour, seat of phonatory vibration, vocal fold morphology and motility, level of the vocal fold, stops of vocal fold mucosa vibration). This form was created in 2002 during the elaboration of the protocol for the assessment of dysphonia of the Italian Society of Phoniatrics and Logopedics, which follows the guidelines of the European Laryngological Society published in 2001. We used this form for 15 years in our daily laryngological practice with great satisfaction. We propose a more detailed version of this form, which provides for drawings which show the various videolaryngostroboscopic findings, helping the laryngologist in the collection of videolaryngostroboscopic examination basic findings.

Mechanical regulation of human vocal fold stellate cells.

OBJECTIVE: It is generally accepted that tensile and compressive strains have direct effects on cell morphology and structure, including changes in cytoskeletal structure and organization. Cytoskeletons play the role of mechanoreceptor of the cells. Vocal fold stellate cells (VFSCs) in the human maculae flavae (MFe) are inferred to be involved in the metabolism of extracellular matrices essential for the viscoelasticity of the vocal fold mucosa. Our previous studies have supported the hypothesis that the tension caused by phonation (vocal fold vibration) regulates the behavior of the VFSCs. The microstructure of the intermediate filaments and the expression of their proteins were investigated in VFSCs in the MFe, which had remained unphonated since birth. METHODS: Three adult vocal fold mucosae that had remained unphonated since birth were investigated by immunohistochemistry and electron microscopy. RESULTS: The intermediate filaments of the VFSCs were fewer in number. The expression of their characteristic proteins (vimentin, desmin, and glial fibrillary acidic protein) was also reduced. CONCLUSION: Vocal fold vibration seems to affect VFSC morphology and structure, such as cytoskeletal structure and organization. This supports the hypothesis that vocal fold vibration regulates VFSC behavior in the human MFe. In addition to chemical factors, mechanical factors also appear to modulate VFSC behavior.

A new rat model for investigation of subglottic stenosis.

CONCLUSION: This study attempted to develop a new rat model of subglottic stenosis (SGS), resulting from subglottic mucosal injury administered by electrocauterization. Despite failure of the posterior SGS model, the anterior SGS model was considered feasible. OBJECTIVE: To investigate the feasibility of using rats as an animal model for SGS. METHODS: Thirty-seven female Sprague-Dawley rats were assigned to the control group or to the anterior or posterior subglottic injury group. Electrical cauterization was performed on the anterior or posterior 180° of the subglottic mucosa. Animals were euthanized at 4 weeks after injury. Histologic features of the subglottis were evaluated as regards changes in the subglottic lumen, lamina propria, cartilage, and epithelium after hematoxylin and eosin and Masson trichrome staining. RESULTS: Survival in the anterior injury group was 80% (13/15) until 4 weeks, and results of histologic evaluation showed an increase in thickness of lamina propria with fibrosis and cartilage damage, resulting in luminal narrowing. A high rate of mortality was observed in the posterior injury group.

Consequences of chronic nasal obstruction on the laryngeal mucosa and voice quality of 4- to 12-year-old children.

INTRODUCTION: Dysphonia affects 6% to 23% of children, and chronic nasal obstruction may participate in its pathophysiology. OBJECTIVES: To study the effects of chronic nasal obstruction on children's vocal quality. SUBJECTS AND METHODS: Two study groups were formed: nasal obstruction group (NOG), consisting of 60 children aged 4-12 years with important symptoms of chronic nasal obstruction; and a control group (CG), similar in gender and age range, consisting of healthy students without nasal, vocal, or auditory symptoms. The parents answered a questionnaire containing questions concerning their children's vocal qualities. All the children were submitted to perceptual auditory analysis, acoustic vocal analysis, auditory acuity assessment (transient otoacoustic emissions and/or threshold tone audiometry), and videoendoscopic assessment (flexible laryngoscopy and rigid laryngoscopy). RESULTS: The groups were similar in age and gender. Parents reported a dysphonia rate of 76.6% in NOG and a vocal abuse rate of 68.3%. Eight children from NOG (13.34%) showed mild conductive hypoacusia. Laryngeal lesions were detected in 35 children from NOG (58%): inflammatory processes (n=19), mucosal thickening (n=10), nodules (n=5), and cyst (n=1). In children from the NOG were observed higher scores for the Grade, Roughness, Breathiness, Aesthenia, Strain, Instability (GRBAS) perceptual scale (P<0.05), lower maximum phonation time values, and higher values to the s/z ratio, insufficient nasal resonance. CONCLUSIONS: Relevant changes in perceptual auditory and acoustic vocal analyses and in the videolaryngoscopy were detected in children with nasal obstruction. These results showed the importance of the assessment of nasal obstruction in dysphonic children.

Lesion of the nucleus solitarius leads to impaired laryngeal sensation in bulbar palsy patients.

BACKGROUND: In order to clarify the laryngeal sensation of bulbar palsy patients, we studied the relationship between laryngopharyngeal sensation and brainstem lesion in patients with dysphagia caused by bulbar palsy. METHODS: Fifteen patients with lateral medullary infarction and dysphagia were included in this study. We performed laryngeal sensory test using the flexible laryngoscope and probes method previously developed by Yaguchi et al. The test sites included the right and left tip of the laryngeal surface of the epiglottis and bilateral arytenoid regions. Lesion sites were identified by magnetic resonance imaging and classified horizontally according to Kim's classification. We also used the anatomical atlas Cytoarchitecture of the Human Brain Stem to determine whether the lesions included the nucleus solitarius and nucleus ambiguus. RESULTS: Eight cases had normal sensation and 7 cases had decreased sensation of the affected side of the epiglottis and arytenoid region. The lesions of decreased laryngeal sensation group were classified horizontally as large type or dorsal type and included the nucleus solitarius. Decreased laryngeal sensation was significantly correlated with lesions that included the nucleus solitarius (Fisher exact test; P = .026). CONCLUSIONS: This study clarifies that patients with dysphagia caused by bulbar palsy may present with laryngeal sensory impairment of the affected side and laryngopharyngeal movement disorder. The important finding is that damage to both the nucleus solitarius and ambiguus cause dysphagia accompanied by decreased laryngeal sensation and that the lesions are relatively extensive and affect the middle level of the dorsal medulla.

'Flaccid neoglottis' following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system.

OBJECTIVE: Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had 'flaccid neoglottis', i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication. METHOD: The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated. RESULTS: Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this. CONCLUSION: Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.

The effects of cigarette smoke condensate on vocal fold transepithelial resistance and inflammatory signaling in vocal fold fibroblasts.

OBJECTIVES/HYPOTHESIS: In response to chronic cigarette smoke exposure, a subset of patients present with edematous vocal folds, characteristically referred to as Reinke's edema. This phenotype differs from the tissue changes associated with prolonged smoke exposure in the lower airway, and the mechanism underlying Reinke's edema remains poorly described. We hypothesize that the effects of smoke are diffuse and involve both the epithelium and mucosa. STUDY DESIGN: In vitro, ex vivo experiment. METHODS: Transepithelial resistance (R(T) ) was quantified in an ex vivo, viable, porcine vocal fold model. Excised tissue was exposed to cigarette smoke condensate (CSC) and R(T) was computed at baseline and 1 and 4 hours after exposure. In vitro, human vocal fold fibroblasts were exposed to CSC. Cyclooxygenase 2 (COX-2), microsomal prostaglandin E synthase-1, and 15-hydroxyprostaglandin dehydrogenase mRNA expression were assessed at 4 hours. Prostaglandin E2 (PGE2) synthesis was quantified via immunoassay following 24 hours of CSC exposure. RESULTS: CSC had no effect on R(T) . CSC did, however, induce COX-2 mRNA expression as well as its downstream lipid mediator PGE2. PGE2 metabolism appears to be regulated via both synthetic and degradative enzymes in response to cigarette smoke. CONCLUSIONS: In vitro, CSC initiates an inflammatory response in vocal fold fibroblasts. However, in isolation, the epithelial resistance is not altered by CSC, at least acutely. These data may suggest a role for the interaction between the inflammatory response in the mucosa and compromised epithelial barrier function, as has been shown in other tissues.

Simulated reflux decreases vocal fold epithelial barrier resistance.

OBJECTIVES/HYPOTHESIS: The vocal fold epithelium provides a barrier to the entry of inhaled and systemic challenges. However, the location of the epithelium makes it vulnerable to damage. Past research suggests, but does not directly demonstrate, that exposure to gastric reflux adversely affects the function of the epithelial barrier. Understanding the nature of reflux-induced epithelial barrier dysfunction is necessary to better recognize the mechanisms for vocal fold susceptibility to this disease. Therefore, we examined the effects of physiologically relevant reflux challenges on vocal fold transepithelial resistance and gross epithelial and subepithelial appearance. STUDY DESIGN: Ex vivo, mixed design with between-group and repeated-measures analyses. METHODS: Healthy, native porcine vocal folds (N = 52) were exposed to physiologically relevant acidic pepsin, acid-only, or pepsin-only challenges and examined with electrophysiology and light microscopy. For all challenges, vocal folds exposed to a neutral pH served as control. RESULTS: Acidic pepsin and acid-only challenges, but not pepsin-only or control challenges significantly reduced transepithelial resistance within 30 minutes. Reductions in transepithelial resistance were irreversible. Challenge exposure produced minimal gross changes in vocal fold epithelial or subepithelial appearance as evidenced by light microscopy. CONCLUSIONS: These findings demonstrate that acidic environments characteristic of gastric reflux compromise epithelial barrier function without gross structural changes. In healthy, native vocal folds, reductions in transepithelial resistance could reflect reflux-related epithelial disruption. These results might guide the development of pharmacologic and therapeutic recommendations for patients with reflux, such as continued acid-suppression therapy and patient antireflux behavioral education.

Measurement of the viscoelastic properties of the vocal folds.

OBJECTIVES: Studies of the viscoelastic properties of the vocal folds are normally performed with rheometers that use parallel plates whose interplate space is usually arbitrarily assigned a fixed value. In tissues subject to variation of thickness between samples, fixed gaps could result in different compressions, compromising the comparison among them. We performed an experimental study to determine whether different compressions can lead to different results in measurements of dynamic viscosity (DV) of vocal fold samples. METHODS: We measured the DV of vocal fold samples of 10 larynges of cadavers under 3 different compression levels, corresponding to 0.2, 0.5, and 10 N on an 8-mm-diameter parallel-plate rheometer. RESULTS: The DV directly varied with compression. We observed statistically significant differences between the results of 0.2 and 10 N (p = 0.0396) and 0.5 and 10 N (p = 0.0442). CONCLUSIONS: The study demonstrated that the level of compression influences the DV measure and suggests that a defined compression level should be used in rheometric studies of biological tissues.

Hoarseness as a sign of possible nonspecific mucosal hyperreactivity in vocal tract.

The aim of the present paper was to evaluate the possible impact of methacholine challenge on the voice and vocal tract in 10 patients reporting hoarseness due to presumable hyperreactivity to some environmental factors. Ten age and gender-matched healthy subjects served as controls. Methacholine was used for hypersensitivity challenge and saline solution (0.9% NaCl) as control substance. Subjects were examined on two separate challenge occasions testing either methacholine in increasing doses (3, 6, 12 mg) or NaCl. Voice recordings, videolaryngoscopy, and measurement of nasal secretion were performed before and after each sniffing session. Subjective complaints were documented. Data were statistically analyzed with three-way analysis of variance and group comparisons performed. Perceptual analysis of voice recordings showed an increase of the grade of voice disorder in patients after exposure to both substances. Moreover, one of the patients became aphonic and another severely dysphonic after NaCl. No voice quality changes were detected in controls. The videolaryngoscopy findings divergent from normal did not increase in any group. Nasal secretion was significantly higher after sniffing of methacholine than NaCl in both groups. The frequency of subjective complaints was equal in both groups after both substances. However, there was a qualitative difference in the character of the symptoms: the patients complained of throat, vocal, and nasal symptoms whereas the controls complained exclusively of nasal symptoms. The study supports the view that vocal dysfunction after exposure to non-specific environmental irritating factors may be triggered mainly by emotional mechanisms such as off-warding reaction or dissociative disorder.

The laryngeal chemoreflex: an evaluation of the normoxic response.

OBJECTIVES: The laryngeal chemoreflex is a reflexive central apnea, bradycardia, and cardiovascular collapse that occurs in young, maturing mammals in response to exposure of the laryngeal mucosa to acidic and/or organic stimuli. The severity of the laryngeal chemoreflex varies within a species from one animal to another, and in some animals, the response can be fatal. This study seeks to identify those factors that contribute to fatal laryngeal chemoreflex responses when the larynx is stimulated under normoxic conditions, and to define how the normoxic response differs from the hypoxic laryngeal chemoreflex response. STUDY DESIGN: This is a prospective study evaluating the response to laryngeal stimulation of 80 newborn piglets. METHODS: The laryngeal chemoreflex response was elicited from 67 piglets under normoxic conditions. The data were collected from a combination of three separate experimental protocols, each of which included inducing the laryngeal chemoreflex under normoxic conditions as the first step. The physiologic response was recorded with a combination of arterial blood gas, pulse oximetry, blood pressure, and continuous cardiac monitoring. RESULTS: Resumption of respirations occurred when the pCO(2) rose by a mean of 8.34 (Standard Deviation [SD] = 4.8) mmHg, regardless of response severity (ANOVA, P > .05). Moderate (requiring supplemental O(2) for recovery) and profound (fatal) responders had a significantly higher prestimulation pCO(2) (95% confidence interval [CI] 39.8-44.8 mmHg and 40.5-46.4 mmHg, respectively) than did mild (recovery without assistance) responders (95% CI 36.8-40.8 mmHg, ANOVA, P < .05). Baseline pH was statistically significantly different as a function of response severity (95% CI profound: 7.29-7.37, moderate: 7.33-7.38, and mild 7.36-7.39, P < .05). CONCLUSIONS: Accumulation of arterial CO(2) is associated with resumption of respirations during the normoxic laryngeal chemoreflex. The combination of an elevated prestimulation pCO(2) and a low prestimulation pH predicts a profound laryngeal chemoreflex response under normoxic conditions.

[Relationship between vocal fold leukoplakia and gastropharyngeal reflux:analysis of 15 cases].

OBJECTIVE: To explore the possible relationship between vocal fold leukoplakia and gastropharyngeal reflux. METHODS: Fifteen patients with vocal fold leukoplakia confirmed by pathology, all males, aged (53 +/- 14) (20-88), underwent esophageal and laryngopharyngeal 24-hour pH monitoring before operation. The rate and characteristics of reflux were recorded. Semi-open-ended questionnaire was used to assess the symptoms. RESULTS: Nine of the 15 patients (60%) showed pathologic intra-esophageal reflux. The time of total acid reflux of the positive re intra-esophageal reflux group was 104.6 min +/- 42.1 min, significantly longer than that of the negative group [(10.9 min +/- 11.5 min), P = 0.001]. The frequencies of intra-esophageal acid reflux of the positive group was (30.1 +/- 16.2) times, significantly higher than that of the negative group [(4.8 +/- 3.4) times, P = 0.006]. The intra-esophageal acid reflux percentage of the positive group was 7.9% +/- 2.9%, significantly higher than that of the negative group [(1.0% +/- 0.6%), P = 0.01]. and the rate in esophageal pH <4 of total fraction time between reflux positive and negative patients (P < 0.01). The scores of heartburn and acid regurgitation of the positive group were significantly higher than those of the negative group (both P < 0.05). Two of 15 patients (13.3%) had pathologic laryngopharyngeal reflux. One patient also had obstructive sleep apnea hypopnea syndrome. CONCLUSION: The patients with vocal fold leukoplakia had more pathologic intra-esophageal reflux compared to the normal individuals. Reflux may be a risk factor of mucosa leukoplakia. Leukoplakia;

Laryngopharyngeal abnormalities in hospitalized patients with dysphagia.

OBJECTIVES: To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES). STUDY DESIGN: Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video-recorded by a speech-language pathologist (SLP). METHODS: Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings. RESULTS: Sixty-one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy-six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty-five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated. CONCLUSIONS: Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow-up of mucosal and neuromuscular findings that do not respond to medical management.