Does Epiglottic Deflection Contribute to Airway Protection in Patients Living With Dementia?

Epiglottic deflection is thought to help prevent airway invasion by sealing off the laryngeal vestibule during a normal swallow. This study examines epiglottic deflection and its relationship with airway protection in patients living with dementia. Through a retrospective analysis of videofluoroscopy swallowing studies, thin liquid swallow trials from 44 participants (age range 46–100 years) were extracted and analyzed in duplicate by blinded raters. The raters judged epiglottic deflection using the Modified Barium Swallow Impairment Profile (Martin-Harris, 2018) and airway invasion during the swallow using the Penetration-Aspiration Scale (Rosenbek et al., 1996). We converted epiglottic deflection and Penetration-Aspiration Scale scores to binary variables in order to conduct chisquare tests to compare airway invasion versus no airway invasion and complete versus incomplete epiglottic deflection. Analyses revealed no significant differences in swallow safety based on epiglottic deflection. We conducted post hoc analyses to determine the reason for incomplete epiglottic deflection based on previous literature suggesting that epiglottic movement is dependent on hyoid movement, base of tongue retraction, laryngeal vestibule closure, and/or reduced pharyngeal constriction. Binary logistic regression analysis demonstrated that epiglottic deflection was only influenced by hyoid movement in this sample. This study suggests that the epiglottis does not play a vital role in airway protection in patients with dementia, and its deflection is solely related to hyoid displacement in this population. Future research should investigate the physiological impairments interfering with mechanisms of airway protection and the kinematics related to epiglottic deflection in patients with dementia.