Pharyngeal residue and aspiration and the relationship with clinical/nutritional status of patients with oropharyngeal dysphagia submitted to videofluoroscopy

Oliveira, D. L.; Moreira, Emília Addison Machado; Freitas, Maiara Brusco de; Gonçalves, Jussara Maria; Furkim, Ana Maria; Clavé, Père

doi:10.1007/s12603-016-0754-6

Cited by 21 publications

(15 citation statements)

References 40 publications

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“…Still, this finding highlights an imbalance in research focus that has the potential to minimize the occurrence and clinical importance of post-swallow residue. In non-MND populations, post-swallow residue has been linked with malnutrition [80–82], which poses an inevitable concern faced by individuals with ALS and related MNDs. Further, some reports from instrumental assessment show that the occurrence of post-swallow residue is more frequent than aspiration [44,52,58–60,62] in patients with ALS, and may even present an independent risk factor for later aspiration events [39,40,66].…”

Section: Discussionmentioning

confidence: 99%

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

et al. 2017

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Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to explore the degree to which research is capturing the symptom of dysphagia in MND, we conducted a scoping review of the existing literature. The primary aims of this review were to identify common themes within the literature on dysphagia in MND, explore patterns and trends in research focus, and identify if any imbalances exist between the research themes related to dysphagia description and management. Methods A comprehensive search strategy yielded 1690 unique articles for review. Following relevance screening, a total of 157 articles were included in the synthesis. Relevant data and keywords were extracted from each article and grouped into themes. Frequency estimates were calculated for each theme to identify trends across research literature. Results Swallowing impairment in MNDs is described in a variety of ways across current research. The most commonly reported theme was Aspiration/Penetration, mentioned in 73.2% of all included articles; a significant imbalance was identified between reports of swallowing safety and efficiency (p=0.008). The most frequently reported theme related to dysphagia management was Enteral Nutrition, and very few studies have reported on the efficacy of Rehabilitation/Compensatory recommendations. Conclusions It is suggested that researchers and clinicians remain mindful of imbalances and gaps in research, and aim to characterize dysphagia in MNDs in a comprehensive manner. Further research investigating discrete, measureable changes in swallowing pathophysiology would be beneficial to delineate the key factors contributing to impaired swallowing safety and efficiency.

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Section: Discussionmentioning

confidence: 99%

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

et al. 2017

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“…Dysphagia severity, swallowing safety, and swallowing efficacy were rated with validated ordinal scales. Swallowing safety refers to the ability to transfer the bolus from the mouth to the stomach without penetration or aspiration into the lower airways, which is associated with respiratory complications; swallowing efficacy refers to the ability to transfer the bolus from the mouth to the stomach without post-swallow pharyngeal residue and is associated with nutritional complications 28 , 29 .…”

Section: Methodsmentioning

confidence: 99%

Fiberoptic endoscopic evaluation of swallowing in early-to-advanced stage Huntington’s disease

Schindler

Pizzorni

Sassone

et al. 2020

Sci Rep

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Huntington's disease (HD) is a neurodegenerative disorder characterized by motor disturbances, cognitive decline, and behaviour changes. A well-recognized feature of advanced HD is dysphagia, which leads to malnutrition and aspiration pneumonia, the latter being the primary cause of death in HD. Previous studies have underscored the importance of dysphagia in HD patients with moderate-to-advanced stage disease, but it is unclear whether dysphagia affects patients already at an early stage of disease and whether genetic or clinical factors can predict its severity. We performed fiberoptic endoscopic evaluation of swallowing (FEES) in 61 patients with various stages of HD. Dysphagia was found in 35% of early-stage, 94% of moderate-stage, and 100% of advanced-stage HD. Silent aspiration was found in 7.7% of early-stage, 11.8% of moderate-stage, and 27.8% of advanced-stage HD. A strong correlation was observed between disease progression and dysphagia severity: worse dysphagia was associated with worsening of motor symptoms. Dysphagia severity as assessed by FEES correlated with Huntington’s Disease Dysphagia Scale scores (a self-report questionnaire specific for evaluating swallowing in HD). The present findings add to our understanding of dysphagia onset and progression in HD. A better understanding of dysphagia onset and progression in HD may inform guidelines for standard clinical care in dysphagia, its recognition, and management.

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“…Patients who aspirate food and liquids into the airway are at increased risk of developing pneumonia 8 . Factors associated with increased aspiration risk include salivary pooling 9 , impaired sensation 10 , reduced airway protection 11 and pharyngeal residue 12,13 . Murray et al reported a significant association between accumulated secretions and aspiration of food and/or drink, observed during endoscopic evaluation of older individuals, including patients with mixed aetiology and healthy persons 9 .…”

Section: Introductionmentioning

confidence: 99%

The correlation between pharyngeal residue, penetration/aspiration and nutritional modality: a cross-sectional study in patients with neurogenic dysphagia

Nordio

Stadio

Koch

et al. 2020

Acta Otorhinolaryngol Ital

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Aspiration risk has a substantial influence on clinical management of swallowing disorders, and can be associated with pharyngeal residue. The aims of this cross-sectional study are to examine the correlation between the presence of pharyngeal residue and penetrationaspiration during fiberoptic endoscopic evaluation of swallowing (FEES), examine the correlation between objective data and Functional Oral Intake Scale (FOIS) and determine whether using objective assessment (Pooling score and Penetration Aspiration Scale-PAS) to categorise patients as pathological or not identifies the same patients identified by FOIS. Fifty-five patients with neurogenic dysphagia were evaluated during FEES by using the Pooling Score scale and PAS. They underwent an assessment of nutritional modalities using FOIS. There was a significant positive correlation between Pooling score and PAS scores for semisolid bolus (Pearson = 0.305; p = 0.024) and liquids (Pearson = 0.841; p = 0.000). The semi-solid bolus Pooling score had a negative correlation with FOIS (Pearson =-0.355; p = 0.008), but there were no other significant correlations for FOIS with Pooling score or PAS. There were significant differences between objective assessments (P-score/PAS) and functional measure (FOIS) for identifying patients as pathological; although the positive predictive values were high, the negative predictive values were very low. Although pharyngeal residues are significantly associated with the presence of penetration-aspiration during endoscopy, the real intake modalities are not correlated with objective assessments of swallowing disorders. Therefore, clinicians need to implement a comprehensive approach to assess dysphagia.

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Pharyngeal residue and aspiration and the relationship with clinical/nutritional status of patients with oropharyngeal dysphagia submitted to videofluoroscopy

Abstract: In the present study, neurologic diseases, HNC, male sex and underweight were associated to impaired swallowing efficacy. Underweight, independently of the other variables, was not associated with impaired swallowing safety.

Cited by 21 publications

References 40 publications

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

Fiberoptic endoscopic evaluation of swallowing in early-to-advanced stage Huntington’s disease

The correlation between pharyngeal residue, penetration/aspiration and nutritional modality: a cross-sectional study in patients with neurogenic dysphagia

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