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Peer-reviewedCC BY-NC-NDRespirology case reports

Beyond the Larynx: New Insights Into Upper Airway Responses to Mechanical Insufflation–Exsufflation

  • Alessandra Carneiro Dorça1
  • Edna Maria de Sena Souza Rocha1
  • Murilo Bufaíçal Marra2,3
  • Letícia de Araújo Morais4
  • Tiina Maarit Andersen5,6
6 affiliations
  1. 1Alessandra Dorça Institute Goiânia Brazil.
  2. 2Federal University of São Paulo, Paulista School of Medicine São Paulo Brazil.
  3. 3Center for Rehabilitation and Readaptation Dr. Henrique Santillo (CRER) Goiânia Brazil.
  4. 4Estácio de Sá University Center of Goiás Goiânia Brazil.
  5. 5Institute of Health and Functioning Western Norway University of Applied Sciences Bergen Norway.
  6. 6Thoracic Department Haukeland University Hospital Bergen Norway.
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Abstract

This case report describes a 44-year-old man with amyotrophic lateral sclerosis (ALS) and ineffective secretion clearance despite home use of mechanical insufflation-exsufflation (MI-E). He reported upper airway obstruction, respiratory discomfort and recurrent aerophagia during therapy. Dynamic assessments using transnasal flexible laryngoscopy and videofluoroscopy under different MI-E settings showed that upper airway responses were strongly influenced by inspiratory flow, pressure levels, expiratory time and cervical positioning. Higher inspiratory flow and pressure induced supraglottic closure and airflow diversion to the oesophagus. In contrast, lower inspiratory flow combined with reduced expiratory pressure and shorter expiratory time improved glottic opening, maintained airway patency and enhanced cough mechanics. Spontaneously adopted cervical extension optimized airflow and minimized oesophageal insufflation, whereas neutral alignment impaired cough efficiency. These findings emphasize the importance of individualized MI-E settings and patient-specific biomechanics in optimizing therapy in ALS.

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Cite

BibTeXRIS
BibTeX
@article{dorca2026beyond,
  title = {{Beyond the Larynx: New Insights Into Upper Airway Responses to Mechanical Insufflation–Exsufflation}},
  author = {Alessandra Carneiro Dorça and Edna Maria de Sena Souza Rocha and Murilo Bufaíçal Marra and Letícia de Araújo Morais and Tiina Maarit Andersen},
  journal = {Respirology case reports},
  year = {2026},
  month = oct,
  doi = {10.1002/rcr2.70792},
  url = {https://europepmc.org/article/PMC/PMC13717380},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Beyond the Larynx: New Insights Into Upper Airway Responses to Mechanical Insufflation–Exsufflation
AU  - Alessandra Carneiro Dorça
AU  - Edna Maria de Sena Souza Rocha
AU  - Murilo Bufaíçal Marra
AU  - Letícia de Araújo Morais
AU  - Tiina Maarit Andersen
PY  - 2026
DA  - 2026/10/29
JO  - Respirology case reports
DO  - 10.1002/rcr2.70792
UR  - https://europepmc.org/article/PMC/PMC13717380
AB  - This case report describes a 44-year-old man with amyotrophic lateral sclerosis (ALS) and ineffective secretion clearance despite home use of mechanical insufflation-exsufflation (MI-E). He reported upper airway obstruction, respiratory discomfort and recurrent aerophagia during therapy. Dynamic assessments using transnasal flexible laryngoscopy and videofluoroscopy under different MI-E settings showed that upper airway responses were strongly influenced by inspiratory flow, pressure levels, expiratory time and cervical positioning. Higher inspiratory flow and pressure induced supraglottic closure and airflow diversion to the oesophagus. In contrast, lower inspiratory flow combined with reduced expiratory pressure and shorter expiratory time improved glottic opening, maintained airway patency and enhanced cough mechanics. Spontaneously adopted cervical extension optimized airflow and minimized oesophageal insufflation, whereas neutral alignment impaired cough efficiency. These findings emphasize the importance of individualized MI-E settings and patient-specific biomechanics in optimizing therapy in ALS.
SN  - 2051-3380
ER  -