Glottal insufficiency and the associated risk of dysphagia

The most common etiology of glottal insufficiency is vocal fold paralysis usually from damage to the nerve supplying the laryngeal muscles. Glottal closure is an important part of the mechanism that protects the airway during the normal swallow. Vocal fold paralysis or atrophy disrupts the normal closure of glottis during swallowing, thus placing patient at increased risk for aspiration. Treatment of glottal insufficiency can be classified as surgical, provided by the otolaryngologist, or non-surgical. Non-surgical treatment includes voice therapy which may incorporate resonant voice therapy, counseling and massaging techniques. Swallowing rehabilitation, another form of non-surgical intervention, consists of direct therapy (swallowing maneuvers, head postures, or changes in diet consistencies) or indirect therapy (swallowing exercises), or combined.