The findings of this study indicated that 0.2 mL of 4% lidocaine enhanced exam tolerability and did not impair the swallow in dysphagic patients.

Background: There is no appropriately validated scale with which to rate the problem of residue after swallowing. The Boston Residue and Clearance Scale (BRACS) was developed to meet this need. Initial reliability and validity were assessed. Methods: BRACS is an 11-point ordinal residue rating scale scoring three aspects of residue during a fiberoptic endoscopic evaluation of swallowing (FEES): (1) the amount and location of residue, (2) the presence of spontaneous clearing swallows, and (3) the effectiveness of clearing swallows. To determine inter-rater and test-retest reliability, 63 swallows from previously recorded FEES procedures were scored twice by 4 raters using (1) clinical judgment (none, mild, mild-moderate, moderate, moderate-severe, severe) and (2) BRACS. Concurrent validity was tested by correlating clinical judgment scores with BRACS scores. Internal consistency of the items in BRACS was examined. A factor analysis was performed to identify important factors that suggest grouping within the 12 location items in BRACS. Results: BRACS showed excellent inter-rater reliability (intraclass correlation coefficient, ICC = 0.81), test-retest reliability (ICC: 0.82-0.92), high concurrent validity (Pearson's r = 0.76), and high internal consistency (Cronbach's α = 0.86). Factor analysis revealed 3 main latent factors for the 12 location items. Conclusion: BRACS is a valid and reliable tool that can rate the severity of residue.

Objectives: Sensation is an integral component of laryngeal control for breathing, swallowing, and vocalization. Laryngeal sensation is assessed by elicitation of the laryngeal adductor reflex (LAR), a brainstem-mediated adduction of the true vocal folds. During Flexible Endoscopic Evaluations of Swallowing (FEES), the touch method can be used to elicit the LAR to judge laryngeal sensation. Despite the prevalence of this method in clinical practice and research, prior studies have yet to examine inter- and intra-rater reliability. Methods: Four speech-language pathologists rated 125 randomized video clips for the presence, absence, or inability to rate the LAR. Fifty percent of video clips were re-randomized and re-rated 1 week later. Raters then created guidelines and participated in formal consensus training sessions on a separate set of videos. Ratings were repeated post-training. Results: Overall inter-rater reliability was fair (κ = 0.22) prior to training. Pre-training intra-rater reliability ranged from fair (κ = 0.35) to almost perfect (κ = 0.89). Inter-rater reliability significantly improved after training (κ = 0.42, P < .001), though agreement did not reach prespecified acceptable levels (κ ≥ 0.80). Post-training intra-rater reliability ranged from moderate (κ = 0.49) to almost perfect (κ = 0.85). Conclusion: Adequate inter-rater reliability was not achieved when rating isolated attempts to elicit the LAR. Acceptable within-rater reliability was observed in some raters 1 week after initial ratings, suggesting that ratings may remain consistent within raters over a short period of time. Limitations and considerations for future research using the touch method are discussed.

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