The purpose of this prospective study was to investigate the predictive value of oropharyngeal secretions by use of 5-point and modified 3-point secretion scales for aspiration of food or liquid and diet recommendation outcomes. One hundred consecutive patients and 4 control subjects participated. The 5-point secretion severity scale correlated highly to aspiration (Spearman's rho = .516, p < .0001) and to diet recommendation outcomes (Spearman's rho = .72, p < .0001). Patients who received tube feedings were more likely to demonstrate a higher secretion level than patients who received oral feedings (Pearson chi squared analysis value = 25.461, p < .0001). Patients with a tracheotomy tube tended to demonstrate higher secretion levels than patients without a tracheotomy tube (Spearman's rho = .446, p < .0001). The relationship of the 3-point secretion severity scale level with aspiration was .488, p < .0001 (Spearman's rho), and that with diet recommendation outcomes was .746, p < .0001 (Spearman's rho).

The purpose of this study was to evaluate radiographically the effects of cervical bracing upon swallowing thin liquids and solid food in normal adults under three cervical bracing conditions. This was a prospective, repeated measures design study. Seventeen healthy adult volunteers between the ages of 30 and 50 were recruited from hospital staff. All subjects reported no previous history of swallowing difficulty or diseases that might affect swallowing. Subjects were radiographically observed swallowing thin liquids and solid food without cervical bracing and with three common cervical orthoses (Philadelphia collar, SOMI, and halo-vest brace). Order of bracing and type of bolus were randomized. Changes in swallowing function (point of initiation of swallow response, presence of pharyngeal residue, airway penetration, hyoid bone movement, diameter of oropharyngeal airway, and durational measurements) were analyzed by two independent raters. Eighty-two percent (14/17) of the subjects demonstrated radiographic changes under one or more of the bracing conditions. Forty-seven percent (8/17) of subjects demonstrated changes with point of initiation of the swallow response, 59% (10/17) demonstrated increased pharyngeal residue, and 23.5% (4/17) demonstrated changes with bolus flow with laryngeal penetration present. Aspiration did not occur under any of the bracing conditions. Changes noted in durational measurements for oral containment and total pharyngeal transit under the bracing conditions were not considered statistically significant. This study shows that cervical bracing does change swallowing physiology in normal healthy adults.

Weconducted a prospe ctive, descriptive study of40 tracheotom ized patients to investigate the relationships between (1) levels of accumulated oropharyngeal secretions and laryngeal penetration/aspiration status, (2) secretion levels and tube-o cclusion status, and (3) tube-occlusion status and aspiration status .Assessments ofsecretion status were quantifi ed with the use ofa 5-point rating scale. All evaluations were made by fib eroptic endoscop ic evaluation of swallowing. Wefound that pati ents with higher secretion levels were more likely to aspirate than were patients with lower secretion levels. Als o, patients who tolerated pla cement of a tube cap had the lowest mean secretion level, and thos e who tolerated only light fin ger occlusion had the highest; likewise, most patients with normal secretion levels tolerated a capped tube, and a plurality ofpatients with profound secretion levels tolerated only light fing er occlusion. Finally, no significant differences were observed with respe ct to occlusion status and aspiration rates.

The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.

This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.