Return of Aspiration-Free Swallow After Laryngotracheal Anesthesia

Swallowing is a complex process involving coordination of multiple muscle groups. Sensation in the throat is very important for swallowing safely. Laryngotracheal anesthetic (LTA, or topical application of lidocaine anesthetic to larynx and trachea) is needed for a variety of in-office laryngology procedures, including examination of the air passage, or tracheobronchoscopy. This causes a temporary decrease in sensation that can affect swallow function and result in aspiration (passage of swallowed material into lungs instead of into esophagus and stomach). It is not known how long this effect lasts. It would be helpful to know this for counseling patients on when they can resume swallowing after a procedure. In general, most patients are advised to avoid eating/drinking for 90 minutes after their procedure to allow for sensation to return. To date, there has been no study characterizing the time required for return of aspiration-free swallow after LTA.

Inclusion criteria

• Age 18 years or older
• Ability of patients to speak and understand English
• Ability for patients to consent for themselves
• Undergoing tracheobronchoscopy procedure for the treatment of airway stenosis
• Eating Assessment Tool (EAT-10) score ≤ 3

Exclusion criteria

• Age less than 18 years
• Patients unable or unwilling to provide informed consent
• Women who are pregnant
• History of abnormal swallowing evaluation, either videofluroscopic study of swallow or functional endoscopic evaluation of swallowing (FEES)
• History of medical condition affecting swallowing, such as

• Neurodegenerative disorders: stroke, traumatic brain injury, dementia, motor neuron disease, myasthenia gravis, cerebral palsy, Gullain-Barre syndrome, poliomyelitis, myopathy, Parksonism, Huntingon's disease, progressive supranuclear palsy, Wilson's disease, vocal fold paralysis
• Connective tissue disorders: polymyositis, dermatomyositis, progressive systemic sclerosis, Sjogren's disease, scleroderma
• History of gastroesophageal tumor
• History of gastroesophageal surgery
• History of recent open central neck surgery (i.e., thyroidectomy, anterior cervical discectomy or fusion)
• History of head and neck cancer
• History of head and neck radiation therapy or chemotherapy