Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: A systematic review of the evidence

Abstract

Background Cervical auscultation (i.e. listening to swallowing sounds) is the most commonly used technique in adjuvant to the clinical feeding examination by speech‐language pathologists worldwide to assess for oropharyngeal aspiration risk in children. Despite its relative popularity in clinical practice, little is known on the clinical utility of cervical auscultation within a paediatric population. Objective To determine the diagnostic test accuracy of the clinical feeding examination with cervical auscultation in the detection of aspiration in children. Type of review Narrative review. Prospero Registration: CRD42017081467 Search strategy: Medline/Pub Med, Embase, CINAHL, AustHealth, Cochrane and UQ (Scopus) were searched up until October 2017. Specifically, the search terms used were: (((oropharyngeal OR respiratory) aspiration) AND (child* OR pediatr* OR paediatr*) and (cervical auscultation OR swallow sounds OR swallowing sounds OR accelerometry OR swallowing acoustics)). The search strategy also included scanning reference lists and citations of retrieved studies. Evaluation method Extracted studies were reviewed by two independent reviewers. Methodological quality of studies was assessed using the QUADAS‐2 tool. Results Only one study met inclusion criteria for this review, which had a bias for flow and timing. Use of cervical auscultation in conjunction with the clinical feeding examination to predict aspiration had a positive predictor value (PPV) of only 0.49 (0.31‐0.66), indicating potential over‐prediction of aspiration when cervical auscultation is used. In contrast a high NPV of 0.92 (0.78‐0.98) was reported indicating that cervical auscultation is useful at ruling out aspiration in children. Conclusion This review highlights the paucity of research studies assessing the accuracy of cervical auscultation as an adjuvant to the clinical feeding examination in aspiration detection within the paediatric population.

Acoustic characteristics associated with liquid swallowing sounds of different bolus consistencies in young healthy adults

“…(2013), in which good to very good inter‐ and intra‐rater reliability of cervical auscultation in detecting oropharyngeal aspiration in children was observed. Similar findings were reported in a later study (Frakking et al., 2017) and a recent systematic review (Frakking et al., 2019). Bergström et al.…”

Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?

“…Cervical auscultation (CA) is an adjunct to the clinical swallow evaluation and may use a stethoscope, microphone or accelerometer to listen to and interpret swallow-respiratory sounds and coordination, in paediatric and adult populations (Almeida, Ferlin, Parente, & Goldani, 2008;Borr, Hielscher-Fastabend, & Lucking, 2007;Cichero & Murdoch, 2002;Frakking, Chang, David, Orbell-Smith, & Weir, 2019;Frakking, Chang, O'Grady, David, & Weir, 2017;Lagarde, Kamalski, & van Den Engel-Hoek, 2016;Leslie, Drinnan, Finn, Ford, & Wilson, 2004;Morini ere, Boiron, Alison, Makris, & Beutter, 2008;Nozue et al, 2017;Stroud, Lawrie, & Wiles, 2002;Youmans & Stierwalt, 2011). Auscultation is regularly used in cardiac and respiratory medicine.…”

A study of acoustic characteristics of voluntary expiratory sounds produced before and immediately after swallowing

“…However, the inspection sites and study designs using VF have been limited because of radiation exposure. There are many alternative assessment methods for detecting dysphagia, such as cervical auscultation (CA) 4 – 6 , repetitive saliva swallowing test 7 , and water swallowing test 7 , 8 . CA has been used for detecting dysphagia and is a noninvasive screening tool for assessing aspiration, penetration, and pharyngeal retention 9 – 11 .…”

“…Several studies have evaluated the diagnostic accuracy of CA using subjective evaluation 4 , 6 , 13 , 14 . Studies focusing on acoustic data detected from the neck during swallowing attempts using VF or VE, reported that the diagnostic accuracy of CA for penetration or aspiration had a sensitivity of 62–94% and a specificity of 50–100% 13 – 15 .…”