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Aerodigestive Disorders

The incidence of a disorder or condition refers to the number of new cases identified in a specified time period. Prevalence refers to the number of individuals who are living with the disorder or condition in a given time period.

The following aerodigestive disorders provide a sample of conditions that can cause feeding, swallowing, voice, and/or laryngeal airway problems that may involve treatment by a speech-language pathologist (SLP). Some problems may be symptomatic or indicative of an aerodigestive disorder but do not involve treatment by an SLP. For example, dysphagia symptoms in individuals with esophageal dysmotility may resolve following medical and/or surgical intervention.

Airway Disorders

  • Laryngeal cleft occurs in 1 out of 10,000–20,000 infants, with slightly higher rates noted in males with a ratio ranging from 1.2:1.0 to 1.8:1.0 (Leboulanger & Garabédian, 2011). Approximately 41% of patients with laryngeal cleft were found to silently aspirate (Velayutham et al., 2017).
  • Laryngomalacia was estimated to affect approximately 1 in 2,600–3,100 newborns, and stridor was a reported symptom in the majority of children in the study (Kusak et al., 2017). Estimates reported dysphagia to be present in 41%–50% of patients with laryngomalacia (Simons et al., 2016; Velayutham et al., 2017).

Pulmonary Tract Disorders

  • Chronic obstructive pulmonary disease (COPD) was self-reported by 15.5 million adults in the United States (40.3 cases per 100,000 individuals). Higher prevalence was reported in rural areas (Croft et al., 2018). An increase in compromised swallowing function was reported for adults with COPD over 60 years of age (Ghannouchi et al., 2016).
  • Paradoxical vocal fold movement (PVFM) has been associated with chronic cough (Vertigan, Gibson, et al., 2007) and asthma (Ciccolella et al., 1997). True prevalence of PVFM is unknown due to inconsistent diagnostic criteria and a lack of awareness of the disorder. However, studies have reported PVFM as a subset of the investigated clinical population. For example, PVFM was estimated to occur in 2.5%–22% of emergency room patients presenting with shortness of breath or asthma (Ciccolella et al., 1997; Jain et al., 1999).
    • Across the life span, reports estimated that PVFM is more common in females than in males, with a ratio ranging from 2:1 to 3:1 (Brugman, 2003; Morris et al., 2006).
    • Increased rates of PVFM were reported in elite athletes (Rundell & Spiering, 2003), in individuals with elevated stress (Dietrich et al., 2008), and in individuals exposed to irritants (e.g., reflux, allergens; Perkner et al., 1998).

Upper Digestive Tract Disorders

  • Gastroesophageal reflux disease (GERD) is associated with many aerodigestive disorders, including, but not limited to, laryngeal cleft, esophageal atresia, and eosinophilic esophagitis (EoE). Estimates of GERD in individuals with esophageal disorders ranged from 40.2% (Connor et al., 2015) to 65.3% (Mansoor & Cooper, 2016) of patients. Voice disorders and dysphagia may also be associated with GERD. Voice disorders are reported to be 1.8 times higher in patients with GERD (Katz et al., 2013; Poelmans & Tack, 2005).
  • Esophageal atresia/tracheoesophageal fistula was estimated to affect 2.3 out of 100,000 live births in 2017. Prevalence rates of long-term dysphagia in individuals with esophageal atresia ranged from 18.2% to 84.2% (with pooled estimated prevalence of 50.3%; Connor et al., 2015; Coppens et al., 2016). Prevalence of dysphagia decreases as children get older (Coppens et al., 2016), but dysphagia has been commonly indicated in adults who had esophageal atresia repair as children (Taylor et al., 2007).
  • Eosinophilic Esophagitis (EoE) was estimated to affect 71.1 out of 100,000 children and 25.9–55.5 out of 100,000 adults (Mansoor & Cooper, 2016; Maradey-Romero et al., 2015), with a prevalence rate significantly higher in adult men than in adult women (35.8 vs. 17.8 out of 100,000 persons, respectively). Relative to other races and ethnicities, EoE was highest in Caucasians. EoE was estimated to affect 18.6 out of 100,000 elderly persons (Maradey-Romero et al., 2015).
    • Patients with EoE reported dysphagia as a common symptom. Dysphagia was reported in 46.2%–94.5% of adults (Shaheen et al., 2018). Estimates reported that 4.8%–60.9% of children with EoE experience dysphagia and globus sensation, but estimates may be as high as 88% (Soon et al., 2013).

Voice and swallowing problems commonly occur as a result of structural or physiologic changes to the aerodigestive tract secondary to surgery or radiation therapy. For example, the majority of individuals (70.5%) who received a lung transplant and subsequent swallowing evaluation showed laryngeal penetration or aspiration (Atkins et al., 2010). Following an esophagectomy, the incidence of vocal fold paralysis/paresis was estimated to be 1.96% of individuals, with 35% of those individuals receiving speech-language pathology services (Crowson et al., 2018). For more information, visit ASHA’s Practice Portal pages on Head and Neck Cancer, Dysphagia (Adult), and Voice Disorders.

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