Background: Episodes of pulmonary aspiration during swallowing of oropharyngeal contents into the larynx is not so uncommon incidence. However, when severe, it could be an important cause of mortality and morbidity. Such episodes most commonly happen when deglutition reflexes involving closure of the epiglottis and closure of true and false vocal cords and concomitant laryngospasm, during the process of swallowing, do not occur. Coughing reflex is also an important protective reflex against pulmonary aspiration. All these reflexes are impaired or lost when sensory receptors and nerves are damaged or nonfunctioning. Uncontrolled diabetes mellitus for prolonged period leads to generalized peripheral neuropathy, and, hence, there is a possibility of impaired nerves and receptors in the areas of upper respiratory tract also. Therefore, a comparative study on episodes of pulmonary aspiration between normal persons and patients with diabetic neuropathy will not be unreasonable and is, therefore, performed in this work.
Objective: To study preponderance of pulmonary aspiration episodes in patients with diabetic neuropathy.
Materials and Methods: Thirty-seven healthy persons and 30 patients with known diabetic neuropathy of same age group but of both sexes were chosen for the study. They were then asked to note down any coughing and/or choking episodes during swallowing of food and drinks for a period of 1 week. The results of the two groups were compared and analyzed statistically using standard tests of significance.
Results: The results showed that, in control subjects, the fasting blood sugar (FBS) was 85 ± 7.12 mg/dL and, in patients with diabetes, 122.9±26.31mg/dl. The glycosylated hemoglobin A1c (HbA1c) was 5.1% ± 0.72% and 8.46% ± 1.06%, respectively. The number of episodes of coughing and choking incidences during the swallowing of food and drinks (deglutition interruption episodes) in 1-week period was 1.84 ± 1.55 in control subjects and 7.9 ± 2.68 in patients with diabetes. This difference is statistically significant (p < 0.05).
Conclusions: It is shown in our study that the patients with diabetic neuropathy have greater episodes of coughing/choking incidences, proving indirectly that there are more incidences of increased coughing episodes and impairment of other laryngeal airway reflexes leading to incoordination between these and the swallowing reflexes and, thereby, more pulmonary aspiration episodes in these populations. However, more elaborate studies are required to confirm these findings.
Key words: Pulmonary aspiration, diabetes mellitus, diabetic neuropathy
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