Laryngeal Palpation

 

Why Are You Strangling the Patient?

Relax…..  You may walk in to observe a Clinical Swallow Evaluation and see an SLP with 3 fingers on a patient’s neck as the patient is swallowing.

What in the World are they Doing??

It’s called laryngeal palpation.   The ring finger goes on the patient’s cricoid notch, the middle finger is on the Adam’s Apple and the index finger is on the hyoid bone.  As the patient swallows, the SLP “feels” the hyolaryngeal movement and judges the speech of elevation.

What in the Heck is Hyolaryngeal ExWhatsion?

There are many factors to examine during hyolaryngeal excursion.   Hyoid “burst”, superior and anterior excursion of the hyolaryngeal complex.   Many of these key factors have to be viewed during MBSS using frame by frame imaging to determine amount of hyolaryngeal excursion.

The Evidence

One study (Brates, et al 2019) examined 87 patients through laryngeal palpation and Modified Barium Swallow Study to examine Hyolaryngeal Excursion (HE).   In 16 of the patients, HE was thought to be normal at bedside, but was found to be reduced during MBSS.   17 of the patients were thought to have reduced HE at bedside, but found to have normal HE during MBSS.   29 patients were judged to have normal HE at both bedside and during MBSS.

Te authors also stated that “Perceptual judgment is typically used in clinical settings to assess adequacy of hyolaryngeal excursion (HE), though the validity of perceptual techniques for assessing this physiologic component of swallowing has not been established.”

(McCullough and Martino 2003)  “The larynx should be palpated for timing and completeness of the swallow, as well as the number of swallows.” Poor laryngeal elevation on palpation can be an indicator of reduced laryngeal elevation or closure, particularly when combined with coughing or wet voice.

Bretan and Henry 1997 assessed 14 dysphagic patients and a group with normal swallows by palpating both to determine deviance of the dysphagic group.  They found that direct measurement and palpation of laryngeal mobility during swallowing tasks is noninvasive and can be used to evaluate dysphagia and the risk for aspiration as well as to physically monitor progression of dysphagia.

But Can You See It?

Palpation can be a part of your Clinical Swallow Evaluation, however remember that to truly understand hyolaryngeal excursion, you need to be able to visualize the movement of the structures.

References:

Brates, D., Molfenter, S. M., & Thibeault, S. L. (2019). Assessing hyolaryngeal excursion: comparing quantitative methods to palpation at the bedside and visualization during videofluoroscopy. Dysphagia34(3), 298-307.

McCullough, G. H., & Martino, R. (2013). Clinical evaluation of patients with dysphagia: Importance of history taking and physical exam. In Manual of diagnostic and therapeutic techniques for disorders of deglutition (pp. 11-30). Springer, New York, NY.

Bretan, O., & Henry, M. A. (1997). Laryngeal mobility and dysphagia. Arquivos de gastroenterologia34(3), 134-138.

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