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Background: Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. Methods: A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue‐dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. Key Results: The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = −3.82; P = .001), 0.3 mL (t = −4.65; P < .000), 0.4 mL (t = −5.77; P < .000), and 0.5 mL (t = −3.49; P = .005). Conclusion and Inferences: Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia. [ABSTRACT FROM AUTHOR]

Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network. [ABSTRACT FROM AUTHOR]