Giraldo-Cadavid Luis F, Agudelo-Otalora Luis Mauricio, Burguete Javier, Arbulu Mario, Moscoso William Daniel, Martínez Fabio, Ortiz Andrés Felipe, Diaz Juan, Pantoja Jaime A, Rueda-Arango Andrés Felipe, Fernández Secundino
School of Medicine, University of Navarra, Irunlarea 1, 31080, Pamplona, Navarra, Spain.
School of Medicine, University of La Sabana, Autonorte de Bogotá, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia.
Biomed Eng Online. 2016 May 10;15(1):52. doi: 10.1186/s12938-016-0166-1.
Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity.
We designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes.
We initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducting the air-pulses and the site of impact. To control all of these factors, an LPEER consisting of an air-pulse generator and an endoscopic laser range-finder was designed and manufactured. We assessed the precision and accuracy of the LPEER's stimulus and range-finder according to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air-pulses and range-finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range-finder measurement error of <1 mm. The tests in patients demonstrated obtainable and reproducible thresholds for the laryngeal adductor, cough and gag reflexes.
The new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo-pharyngeal reflexes.
喉咽机械敏感性（LPMS）与吞咽困难、睡眠呼吸暂停、中风、喉易激综合征和咳嗽高敏综合征等多种疾病有关。这些病症与多种气道反射异常相关。然而，目前用于探究LPMS的设备存在局限性，因为在吞咽的纤维内镜评估过程中，它仅评估喉内收肌反射，并且需要高度专业知识才能获得可靠结果，从而引入了内在的专家变异性和主观性。
我们基于对气脉冲变异性决定因素以及刺激冲击距离、角度和部位的内在观察者变异性和主观性决定因素的评估与控制，设计、开发并验证了一种新型内置激光测距仪的气脉冲喉咽内镜感觉测量仪（LPEER）。LPEER旨在能够以广泛的强度提供精确且准确的刺激，从而探究大多数喉咽反射。
我们最初探究了影响LPMS测试可靠性的潜在因素，并将这些因素纳入多元线性回归模型。以下因素对测试的精度和准确性有显著影响（P < 0.001）：传导气脉冲的导管、系统的供气压力、气脉冲的持续时间以及传导气脉冲的导管末端与冲击部位之间的距离和角度。为了控制所有这些因素，设计并制造了一种由气脉冲发生器和内镜激光测距仪组成的LPEER。我们根据变异系数（CV）并通过查看测量属性与期望值之间的差异，评估了LPEER刺激和测距仪的精度和准确性，并对10名人类受试者进行了初步验证。气脉冲和测距仪表现出良好的精度和准确性（CV < 0.06），期望值与测量属性之间的差异< 3%，测距仪测量误差< 1毫米。对患者的测试表明，喉内收肌、咳嗽和咽反射的阈值是可获得且可重复的。
新型LPEER能够为探究喉咽反射提供精确且准确的刺激。
