Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in Stroke

Abstract

PURPOSE: This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS: Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS: No association was found between the groups with posterior oral spillage (χ2=1.65; p=0.30; φ2=0.02), but there was statistical difference for the association between pharyngeal residue (χ2=12.86; p=0.003; φ2=0.20) and the groups. CONCLUSION: There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals.

Resíduos faríngeos nas disfagias orofaríngeas neurogênicas

“…In agreement with these studies, although without identifying the quantity and location of pharyngeal residues or the differences among the various dysphagic groups, the present study observed that the frequency of occurrence of pharyngeal residues of the food consistencies studied in neurogenic oropharyngeal dysphagia was higher than the absence of such event. Considering that the presence of pharyngeal residues is related to distinct types of impairment of various biomechanical actions of oropharyngeal swallowing that depend both on oral propulsion and on mechanisms of pharyngeal contraction and the opening of the pharyngoesophageal transition, the possibility of this being a frequent finding in dysphagic symptomatology is considerable and agrees with the literature (18,19,22) . Thus, even though there is consensus in the literature about the frequent presence of pharyngeal residues among subjects with neurogenic oropharyngeal dysphagia, little is known about the quantity or site of occurrence of this event in different populations.…”

“…Several studies have identified and characterized the presence of pharyngeal residues in neurogenic oropharyngeal dysphagia, relating them to the presence of laryngotracheal aspiration (18,19,21,24,25) . In agreement with these studies, although without identifying the quantity and location of pharyngeal residues or the differences among the various dysphagic groups, the present study observed that the frequency of occurrence of pharyngeal residues of the food consistencies studied in neurogenic oropharyngeal dysphagia was higher than the absence of such event.…”

“…Variation in the levels of involvement of pharyngeal residues can be explained according to the physiopathology of swallowing in each base disease. Among post-CVA patients, the pharyngeal residues are associated with the performance of the oral phase and of the pharyngeal response, with the laryngeal elevation and the opening of the pharyngoesophageal transition (11,17,18) . In neurodegenerative diseases such as ALS and PD, the physiopathology of pharyngeal swallowing residues is associated with the neuromuscular deficit present in the oral and pharyngeal phases of swallowing (19)(20)(21)(22)(23)(24) .…”

“…In general, the presence of pharyngeal residues is one of the findings in neurogenic dysphagia, possibly due to the many impairments in the physiopathological mechanisms of oropharyngeal swallowing. Among victims of cerebrovascular accidents (CVA), the impairments in the oral phase, with a reduction of the pharyngeal response, affect the elevation of the larynx and the mechanism of pharyngeal cleaning and of protection of the lower airway, possibly producing pharyngeal residues (11,17,18) . In various neurodegenerative diseases such as Parkinson's disease (PD) and lateral amyotrophic sclerosis (LAS), the presence of pharygeal residues, in addition to being related to impairment of the oral phase, is closely related to the neuromuscular deficits present in the different phases of swallowing in each disease, which affect the oropharynx in distinct ways (19)(20)(21)(22)(23)(24) .…”

Achados videoendoscópicos da deglutição em diferentes consistências de alimento na Esclerose Lateral Amiotrófica

“…Thus, even though the pureed and thickened liquid food consistencies can be considered to be the safest ones for patients with some other neurological diseases, it is of fundamental importance to remember that the present sample of ALS patients was the one that most frequently produced pharyngeal residues, a fact that may potentiate the risk of aspiration (27) .…”