Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy

AbstractOnly limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

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Measurement of Pharyngeal Residue From Lateral View Videofluoroscopic Images

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-19-00314 ◽

2020 ◽

Vol 63 (5) ◽

pp. 1404-1415

Author(s):

Catriona M. Steele ◽

Melanie Peladeau-Pigeon ◽

Ahmed Nagy ◽

Ashley A. Waito

Keyword(s):

Lateral View ◽

Pyriform Sinus ◽

Strong Correlations ◽

Good Correspondence ◽

Data Set ◽

Frequency Distributions ◽

Pharyngeal Residue ◽

Housing Area ◽

Kendall’S Τ ◽

Scale Scores

Purpose The field lacks consensus about preferred metrics for capturing pharyngeal residue on videofluoroscopy. We explored four different methods, namely, the visuoperceptual Eisenhuber scale and three pixel-based methods: (a) residue area divided by vallecular or pyriform sinus spatial housing (“%-Full”), (b) the Normalized Residue Ratio Scale, and (c) residue area divided by a cervical spine scalar (%(C2–4) 2 ). Method This study involved retrospective analysis of an existing data set of videofluoroscopies performed in 305 adults referred on the basis of suspected dysphagia, who swallowed 15 boluses each (six thin and three each of mildly, moderately, and extremely thick 20% w/v barium). The rest frame at the end of the initial swallow of each bolus was identified. Duplicate measures of pharyngeal residue were made independently by trained raters; interrater reliability was calculated prior to discrepancy resolution. Frequency distributions and descriptive statistics were calculated for all measures. Kendall's τ b tests explored associations between Eisenhuber scale scores and pixel-based measures, that is, %-Full and %(C2–4) 2 . Cross-tabulations compared Eisenhuber scale scores to 25% increments of the %-Full measure. Spearman rank correlations evaluated relationships between the %-Full and %(C2–4) 2 measures. Results Complete data were available for 3,545 boluses: 37% displayed pharyngeal residue (thin, 36%; mildly thick, 41%; moderately thick, 35%; extremely thick, 34%). Eisenhuber scale scores showed modest positive associations with pixel-based measures but inaccurately estimated residue severity when compared to %-Full measures with errors in 20.6% of vallecular ratings and 14.2% of pyriform sinus ratings. Strong correlations ( p < .001) were seen between the %-Full and %(C2–4) 2 measures, but the %-Full measures showed inflation when spatial housing area was small. Conclusions Generally good correspondence was seen across different methods of measuring pharyngeal residue. Pixel-based measurement using an anatomical reference scalar, for example, (C2–4) 2 is recommended for valid, reliable, and precise measurement.

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Fiberoptic endoscopic evaluation of swallowing in early-to-advanced stage Huntington’s disease

Scientific Reports ◽

10.1038/s41598-020-72250-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Antonio Schindler ◽

Nicole Pizzorni ◽

Jenny Sassone ◽

Lorenzo Nanetti ◽

Anna Castaldo ◽

...

Keyword(s):

Huntington's Disease ◽

Huntington’S Disease ◽

Neurodegenerative Disorder ◽

Early Stage ◽

Clinical Care ◽

Self Report ◽

Advanced Stage ◽

Endoscopic Evaluation ◽

Silent Aspiration ◽

Scale Scores

Abstract Huntington's disease (HD) is a neurodegenerative disorder characterized by motor disturbances, cognitive decline, and behaviour changes. A well-recognized feature of advanced HD is dysphagia, which leads to malnutrition and aspiration pneumonia, the latter being the primary cause of death in HD. Previous studies have underscored the importance of dysphagia in HD patients with moderate-to-advanced stage disease, but it is unclear whether dysphagia affects patients already at an early stage of disease and whether genetic or clinical factors can predict its severity. We performed fiberoptic endoscopic evaluation of swallowing (FEES) in 61 patients with various stages of HD. Dysphagia was found in 35% of early-stage, 94% of moderate-stage, and 100% of advanced-stage HD. Silent aspiration was found in 7.7% of early-stage, 11.8% of moderate-stage, and 27.8% of advanced-stage HD. A strong correlation was observed between disease progression and dysphagia severity: worse dysphagia was associated with worsening of motor symptoms. Dysphagia severity as assessed by FEES correlated with Huntington’s Disease Dysphagia Scale scores (a self-report questionnaire specific for evaluating swallowing in HD). The present findings add to our understanding of dysphagia onset and progression in HD. A better understanding of dysphagia onset and progression in HD may inform guidelines for standard clinical care in dysphagia, its recognition, and management.

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