Pharyngolaryngeal Abnormalities viewed via nasoendoscopy associated with Oropharyngeal Dysphagia in Adults: A Scoping Review.

To identify in the literature which pharyngolaryngeal abnormalities (PLA) co-occur or are associated with oropharyngeal dysphagia when viewed via nasoendoscopy. Flexible Endoscopic Evaluation of Swallowing (FEES) is an examination used to assess swallowing. Currently there are no standardized frameworks to observe and report on PLAs observed during a FEES procedure to support diagnostics and inform management. Multiple databases (Scopus (Elsevier), Medline (Ovid), CINAHL (EBSCO) and EMBASE (Ovid)) were searched against inclusion criteria from 1980 to 2024. Key search terms included variations of larynx, pharynx, FEES, and oropharyngeal dysphagia. The study utilized PRISMA-ScR reporting items. Two independent reviewers screened in two phases. Reporting of PLAs with oropharyngeal dysphagia was represented using frequency of co-occurrence and, where available, any statistical analyses attempting to demonstrate an association. Prevalence was calculated for PLA and presence of signs/symptoms of oropharyngeal dysphagia. 117 articles were included for full text review. Data were synthesized into 24 PLA within six categories. PLAs with both frequency of co-occurrence and statistical analysis attempting to demonstrate an association with oropharyngeal dysphagia included unilateral vocal fold motion impairment (UVFMI), velopharyngeal insufficiency, arytenoid motion impairment, incomplete glottic closure, vocal fold atrophy/bowing, edema, and hematoma. This scoping review presents evidence relating to PLAs seen via nasoendoscopy and their reported co-occurrence with oropharyngeal dysphagia. Overall, seven PLA were shown to have an association with oropharyngeal dysphagia, and a further 11 PLA had frequency of co-occurrence with oropharyngeal dysphagia without statistical analysis to support association. Whilst these findings suggest a relationship between PLA and oropharyngeal dysphagia, further research is required to confirm causation of each PLA on swallowing function. Systematic swallowing assessment and use of outcome measures that consider the presence of pharyngolaryngeal abnormalities, will help generate rigorous evidence that is needed to advance precision in diagnostics of swallowing impairment and subsequent interventions.