Bolus Residue Scale: An Easy-to-Use and Reliable Videofluoroscopic Analysis Tool to Score Bolus Residue in Patients with Dysphagia

Abstract

Background. We aimed to validate an easy-to-use videofluoroscopic analysis tool, the bolus residue scale (BRS), for detection and classification of pharyngeal retention in the valleculae, piriform sinuses, and/or the posterior pharyngeal wall. Methods. 50 randomly selected videofluoroscopic images of 10 mL swallows (recorded in 18 dysphagia patients and 8 controls) were analyzed by 4 experts and 6 nonexpert observers. A score from 1 to 6 was assigned according to the number of structures affected by residue. Inter- and intrarater reliabilities were assessed by calculation of intraclass correlation coefficients (ICCs) for expert and nonexpert observers. Sensitivity, specificity, and interrater agreement were analyzed for different BRS levels. Results. Intrarater reproducibility was almost perfect for experts (mean ICC 0.972) and ranged from substantial to almost perfect for nonexperts (mean ICC 0.835). Interjudge agreement of the experts ranged from substantial to almost perfect (mean ICC 0.780), but interrater reliability of nonexperts ranged from substantial to good (mean 0.719). BRS shows for experts a high specificity and sensitivity and for nonexperts a low sensitivity and high specificity. Conclusions. The BRS is a simple, easy-to-carry-out, and accessible rating scale to locate pharyngeal retention on videofluoroscopic images with a good specificity and reproducibility for observers of different expertise levels.

Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

“…These investigators studied children utilizing high resolution esophageal pressure topography, impedance, and videofluoroscopy methods 3,49–53 . Notable works that may translate to the neonatal population include: 1) assessment of oropharyngeal dysphagia and aspiration utilizing pressure-flow analysis, a method to assess swallowing physiology by detecting motor function, bolus flow and transit, and correlation with symptoms, 54–58 and 2) development a bolus residue scale to detect pharyngeal retention 59 .…”

The Diagnostic Accuracy of the Pitch Glide to Identify Aspiration in Patients with Respiratory Diseases: A Pilot Study

“…However, Malandraki et al [37] used a 3-point residue scoring system [51] to measure the volume of residue and examined the relationship between pitch glide and pharyngeal residue and concluded that maximum F 0 of sound /a/ was associated with residue in patients with different aetiologies of dysphagia. In the current study the Bolus Residue Scale [45] was used in order to detect and classify residue in the valleculae, piriform sinuses and/or posterior wall of the pharynx. It is important to highlight the fact that these three studies used three different scales and each one was focused on different diagnostic groups.…”

“…The Penetration-Aspiration Scale was used to rate aspiration on 5 mL, 10 mL and the sip of liquids from 1 (material does not enter the airway) to 8 (material enters the airway; passes below the vocal folds, no effort made to eject) [44]. Pharyngeal residue and hyolaryngeal excursion were rated using Bolus Residue Scale and the hyolaryngeal excursion component of the MBSImP, respectively [43, 45]. Residue was rated on a scale from 1 (no residue) to 6 (residue in valleculae and posterior pharyngeal wall and piriform sinus) [45].…”

“…Pharyngeal residue and hyolaryngeal excursion were rated using Bolus Residue Scale and the hyolaryngeal excursion component of the MBSImP, respectively [43, 45]. Residue was rated on a scale from 1 (no residue) to 6 (residue in valleculae and posterior pharyngeal wall and piriform sinus) [45]. On the other hand, hyolaryngeal excursion was rated using a scale from 0 (complete superior movement of thyroid cartilage with complete approximation of arytenoids to epiglottic petiole) to 3 (no superior movement of thyroid cartilage) [43].…”

Clinical Application of Flexible Endoscopic Evaluation of Swallowing in Stroke

“…Bolus retention patterns are associated with specific physiologic impairments. [72][73][74][75] In the stroke population, bolus retention may present in a variety of patterns. One pattern might represent unilateral weakness, in which case secretions, food, or liquid collect in the pharyngeal recesses on the side of weakness.…”