Evaluation of swallowing function in patients with oropharyngeal secretions

Abstract

BackgroundSeveral studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. However, no previous studies have evaluated the accumulation of saliva and swallowing dynamics.ObjectiveThe objective of this study was to examine the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE).MethodsThis retrospective study investigated 47 patients with dysphagia who underwent VF and VE on the same day. Saliva accumulation in the pharynx was assessed on VE and classified by the Murray secretion scale. Pharyngeal residue was assessed on VF. In addition, displacement of the hyoid bone and larynx on swallowing and the opening size of the esophageal orifice were measured, and contact between the base of the tongue and the posterior pharyngeal wall was examined on VF.ResultsModerate correlations were found between saliva accumulation and perpendicular displacement of the larynx and upper esophageal sphincter opening. The percentage of patients showing contact between the base of the tongue and the posterior pharyngeal wall was significantly greater in those with a saliva accumulation score of 0 or 1.ConclusionLess laryngeal elevation and upper esophageal sphincter opening and absence of contact between the base of the tongue and the posterior pharyngeal wall when swallowing tended to result in accumulation of saliva in the pharynx.

Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy

“…, decreased laryngeal sensation, incomplete pharyngeal constriction, and impaired upper esophageal sphincter opening). 27 , 28 Aspiration events could also be caused by swallowing impairment during the oral swallowing phase, such as bolus propulsion and premature spillage. However, compared with food/liquid swallowing, spontaneous swallowing that manage oropharyngeal secretions bypassed the participation of oral phase more frequently.…”

Characteristics of post‐stroke dysphagia: A retrospective study based on FEES

“…Moreover, higher PR and MSS scores were also observed in the infratentorial stroke group, which further indicated the importance of infratentorial brain regions. The accumulation of saliva was reported to correlate with reduced laryngeal sensation, laryngeal displacement, and UES relaxation, all of which were modulated by the infratentorial brain regions (Borders et al., 2019 ; Brady et al., 2016 ; Yamaguchi et al., 2019 ). Furthermore, some anatomical reasons may also be important.…”

Current approaches to reporting pharyngo-laryngeal secretions

“…A number of recently published intervention studies have assessed secretion severity as a primary or secondary outcome measure to determine responses to therapeutic interventions [26,28]; however, only one used a validated tool [28]. The SSRS [4] has been used in a number of articles evaluating patient cohorts, including diabetes [29], ALS [10] and referred dysphagic patients of mixed cause [30 ▪ ,31 ▪▪ ]. The NZSS (validated and published in 2018) [13 ▪▪ ] is being used more often now, perhaps due to its advantage of covering amount, location and response to secretions.…”

“…Yamaguchi et al . [30 ▪ ] provide us with more objective, physiological evidence to understand the pathophysiology underlying pooled secretions. Using same day nasendoscopy and videofluoroscopic swallow studies (VFSS) to evaluate both secretion status and swallow biomechanics, they reported that patients with elevated SSRS scores had reduced horizontal displacement of the hyoid bone, reduced laryngeal movement, reduced upper oesophageal sphincter (UES) opening and absence of base of tongue to posterior pharyngeal wall approximation compared with those with no accumulated secretions.…”