Patterns of Laryngeal Changes on Clinical Application of Mechanical Insufflation-Exsufflation Seen with Transnasal Laryngoscopy for Patients with Varied Neurological Conditions and Bulbar Impairment

Abstract

Mechanical insufflation-exsufflation (MI-E) is an intervention used for cough augmentation in patients with neurological conditions with bulbar impairment. This study aimed to explore implications for clinical practice in the use of transnasal laryngoscopy during MI-E. Twenty-one patients underwent MI-E application with simultaneous transnasal laryngoscopy. Pressures were commenced at +15 cm H2O/-15 cm H2O and titrated according to an agreed algorithm. Outcomes collected included baseline bulbar function scores, optimal MI-E settings, and/or alternative secretion management strategies including medication recommendations. Changes to pressure and/or modality were implemented in all but one patient. No adverse effects of laryngoscopy were seen. For patients with progressive bulbar palsy, limb onset amyotrophic lateral sclerosis, and other conditions with bulbar impairment, transnasal laryngoscopy resulted in discontinuation of MI-E in 54%, 0%, and 14%, respectively. Pressure changes were made for all patients remaining on MI-E and medication changes were made for 47% of patients across all conditions. Transnasal laryngoscopy can be utilised to safely assess the impact of MI-E on laryngeal structures to optimise settings for patients with bulbar impairment. Cough augmentation strategies can be tailored accurately for patients with a variety of neurological conditions with bulbar impairment based on the results of transnasal laryngoscopy.