BACKGROUND: To investigate the swallowing parameters which are related to the subglottic aspiration or supraglottic penetration when 2 cc or 5cc fluid swallowing through the fluoroscopic study METHODS: Fluoroscopic studies (2 cc or 5 cc barium-diluted fluid study) were done in 107 patients clinically suspicious of aspiration. Six oral/pharyngeal parameters (drooling, oral hesitancy, premature bolus loss, delayed epiglottic closure, vallecular residue and pyriform sinus residue) were analyzed whether correlated with the aspiration or penetration. They were also analyzed whether to have the correlation between each other. RESULTS: Degree of pyriform sinus residue and delayed epiglottic closure were correlated with the aspiration (p<0.05). No swallowing parameters had correlation with each other except the relation between the premature bolus loss and the pyriform sinus residue. CONCLUSION: Pyriform sinus residue and delayed epiglottic closure were important parameters to correlate with the aspiration risk in the elderly suspicious of aspiration. They can also be used to judge the aspiration risk when an elderly person swallow the food material.
Aged* ; Deglutition* ; Humans ; Pyriform Sinus

No abstract available.
Fistula* ; Pyriform Sinus* ; Thyroiditis, Suppurative*

This 17-year-old young man attended the oromaxillofacial (OMF) department of a tertiary surgical center. He had attended both local and overseas ENT departments since the age of 5 years. Previous, but unspecified surgery had been performed as a child, with ongoing problems, since with a discharging sinus on the anterior aspect of the lower left side of the neck. On clinical examination, several scars were present on the anterior aspect of the neck, and a skin opening was evident in the left para-midline of the lower neck. Following clinico-radiological discussion a barium swallow was undertaken (Figures 1 and 2).
Human ; Male ; Adolescent ; Pyriform Sinus

OBJECTIVES: To map mechanoreceptor response in various regions of the laryngopharynx. METHODS: Five patients with suspected laryngopharyngeal reflux and six healthy control subjects underwent stimulation of mechanoreceptors in the hypopharynx, interarytenoid area, arytenoids, aryepiglottic folds, and pyriform sinuses. The threshold stimuli evoking sensation and eliciting laryngeal adductor reflex were recorded. RESULTS: In controls, an air pulse with 2 mmHg pressure evoked mechanoreceptor response in all regions, except bilateral aryepiglottic folds of one control. In patients, stimulus intensity to elicit mechanoreceptor response ranged between 2 mmHg and 10 mmHg and varied among the regions. Air pulse intensity differed between right and left sides of laryngopharyngeal regions in the majority of patients. CONCLUSION: Laryngopharyngeal mechanoreceptor response was uniform among regions and subjects in the healthy group. Patients with suspected laryngopharyngeal reflux showed inter- and intra-regional variations in mechanoreceptor response. Laryngopharyngeal sensory deficit in patients with suspected laryngopharyngeal reflux is not limited to aryepiglottic folds.
Humans ; Hypopharynx ; Laryngopharyngeal Reflux ; Mechanoreceptors* ; Pyriform Sinus ; Reflex ; Sensation

OBJECTIVE: To investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS). METHOD: The present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated. RESULTS: In total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (kappa: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement. CONCLUSION: VDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.
Deglutition ; Deglutition Disorders ; Humans ; Lip ; Pyriform Sinus ; Video Recording

Adolescent ; Adult ; Fistula ; congenital ; Humans ; Male ; Pyriform Sinus

Aged ; Humans ; Male ; Pharyngeal Neoplasms ; Polyps ; Pyriform Sinus ; pathology

OBJECTIVE: To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia. METHODS: This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients' swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05). RESULTS: A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001). CONCLUSION: The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.
Barium ; Deglutition Disorders* ; Deglutition* ; Enteral Nutrition ; Humans ; Pyriform Sinus

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.
Diagnosis, Differential ; Laryngocele ; Larynx ; Neurilemmoma ; Pyriform Sinus ; Tracheostomy

Traumatic pyriform sinus perforation is a very rare complication of endotracheal intubation. Forced insertion of endotracheal tube can tear pyriform sinus mucosa. Pyriform sinus perforation can result in deep neck infection which may be potentially lethal. We report a case of pyriform sinus perforation secondary to traumatic intubation, which was successfully treated with primary closure.
Intubation ; Intubation, Intratracheal ; Mucous Membrane ; Neck ; Pyriform Sinus