Predicting penetration–aspiration through quantitative swallow measures of children: a videofluoroscopic study

Dharmarathna, Isuru; Miles, Anna; Allen, Jacqui

doi:10.1007/s00405-021-06629-4

Cited by 14 publications

(7 citation statements)

References 49 publications

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“…A study of VFSS data from pediatric patients up to 21 years old reported that 65% of patients with pharyngeal residue demonstrated positive penetration-aspiration. 20 This finding was consistent with our study in which 41% of infants with oropharyngeal residue, 56% with hypopharyngeal residue, and 64% with laryngeal residue demonstrated aspiration. In addition, static FEES findings and their implications on subsequent VFSS have also been previously evaluated at this institution.…”

Section: Discussionsupporting

confidence: 93%

“…However, these studies did not assess the association between post‐swallow residue and aspiration. A study of VFSS data from pediatric patients up to 21 years old reported that 65% of patients with pharyngeal residue demonstrated positive penetration‐aspiration 20 . This finding was consistent with our study in which 41% of infants with oropharyngeal residue, 56% with hypopharyngeal residue, and 64% with laryngeal residue demonstrated aspiration.…”

Section: Discussionsupporting

confidence: 92%

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Risk of Aspiration Increased by Post‐swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Chang,

Okland,

Johnson

et al. 2023

The Laryngoscope

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ObjectiveTo assess the risk of aspiration associated with post‐swallow residue subsites in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in bottle‐fed infants <1 year of age.MethodsThis is a retrospective matched‐pairs cohort study at an academic tertiary children's hospital. FEES and Videofluoroscopic Swallowing Study (VFSS) trials performed within the same infant <5 days apart were paired by matching bolus consistency and bottle flow rate. Positive aspiration was defined by the “or rule” in which aspiration is positive when either FEES or VFSS within a matched pair is positive.ResultsEighty‐seven FEES‐VFSS matched pairs from 29 patients (16 males; mean [SD] age, 2.9 [2.8] months) were included. The rate of positive aspiration, as defined by the “or rule”, was 59% (51/87). In FEES, post‐swallow pyriform sinus residue was present in 16% (14/87) and anterior commissure residue 27% (31/87). Risk of positive aspiration was increased by pyriform sinus residue (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.9–19.3, p < 0.01) and anterior commissure residue in FEES (OR 2.5, 95% CI 1.1–6.1, p = 0.03). In the neonate subgroup, <1 month of age, multivariate‐adjusted analysis showed that anterior commissure residue had better diagnostic accuracy for aspiration than in older infants (overall 70% vs. 42%, p < 0.01; sensitivity 60% vs. 10%, p < 0.01), whereas pyriform sinus residue had worse accuracy (overall 41% vs. 70%, p = 0.02; sensitivity 13% vs. 43%, p = 0.02).ConclusionThis study demonstrates that pyriform sinus and anterior commissure residue during infant FEES were associated with fivefold and twofold increased risk of aspiration, respectively.Level of Evidence3. Using a retrospective matched‐pairs cohort, this study assesses the diagnostic accuracy of post‐swallow residue in FEES for predicting aspiration. Laryngoscope, 2023

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Risk of Aspiration Increased by Post‐swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Chang,

Okland,

Johnson

et al. 2023

The Laryngoscope

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“…However, the location can be determined and symptoms of dysphagia can be observed by angiography during swallowing. Previous studies have confirmed that dynamic contrast quantitative analysis technology can effectively clarify the relationship between the movements of the organs involved in swallowing as a food bolus passes ( 27–29 ). Applying VFSS to the analysis of muscle relaxation and contraction of the upper sphincter of the esophagus and pharynx can provide more detailed information than can be determined by assessments based on contrast alone.…”

Section: Discussionmentioning

confidence: 89%

Findings of a videofluoroscopic swallowing study in patients with dysphagia

Cui

Wei

et al. 2023

Front. Neurol.

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ObjectiveSwallowing examination is crucial in patients with dysphagia. We aimed to compare qualitative and quantitative videofluoroscopic swallowing study (VFSS) results to provide reference for standardizing quantitative parameters.Materials and methodsIn total, 117 patients with dysphagia were included, 38 with Parkinson’s disease and 39 and 40 in convalescence following cerebral hemorrhage and infarction. VFSS was both qualitatively and quantitatively analyzed.ResultsA significant difference of Oral transit time was found between the oral motor function grades (p < 0.001), also was swallowing reaction times found between swallowing reaction duration grades (p < 0.001), and soft palate lift duration between the soft palate lift grades (p < 0.001). Superior hyoid bone movement (p < 0.001), anterior hyoid bone movement (p < 0.001), hyoid pause time (p < 0.001), and hyoid movement duration (p = 0.032) had significant differences between the hyoid laryngeal complex movement grades, as did the pharyngeal cavity transit time among the cricopharyngeal muscle opening duration grades (p < 0.001). The laryngeal vestibule closure duration differed among the glottic closure grades (p < 0.001). No statistically significant difference in upper esophageal sphincter opening diameter (p = 0.682) or duration (p = 0.682) among the cyclopharyngeal muscle opening duration grades. The pharyngeal area at rest did not significantly differ among the different vallecular residue (p = 0.202) and pyriform sinus residue (p = 0.116) grades.ConclusionSeveral quantitative parameters can reflect the swallowing assessment process well. Further optimization of quantitative parameters is recommended.

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“…Of these, 54 eligible studies were screened for full-text reviews; ultimately, 13 studies met the inclusion criteria and were included [ 6 , 7 , 11 , 12 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Thirty nine studies were excluded [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]; the reasons for exclusion are listed in Table S1 . The most common reasons for exclusion included studying an adult population, a lack of outcomes studied, a lack of exposure of interest or comparison...…”

Section: Resultsmentioning

confidence: 99%

Laryngeal Penetration and Risk of Aspiration Pneumonia in Children with Dysphagia—A Systematic Review

Imdad

Wang

Adlakha

et al. 2023

JCM

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This study was a systematic review and meta-analysis that assessed the risk of aspiration pneumonia in children with laryngeal penetration or tracheal aspiration via a video-fluoroscopic study (VFSS) and compared the results to those for children with neither condition. Systematic searches were conducted using databases, including PubMed, Cochrane Library, and Web of Science. Meta-analysis was used to obtain summary odds ratios (OR) and 95% confidence intervals (CI). The overall quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. In total, 13 studies were conducted with 3159 participants. Combined results from six studies showed that laryngeal penetration on VFSS may be associated with aspiration pneumonia compared to no laryngeal penetration; however, the summary estimate was imprecise and included the possibility of no association (OR 1.44, 95% CI 0.94, 2.19, evidence certainty: low). Data from seven studies showed that tracheal aspiration might be associated with aspiration pneumonia compared to no tracheal aspiration (OR 2.72, 95% CI 1.86, 3.98, evidence certainty: moderate). The association between aspiration pneumonia and laryngeal penetration through VFSS seems to be weaker than that for tracheal aspiration. Prospective cohort studies with clear definitions of laryngeal penetration and that measure clinical and patient reported outcomes are needed to further define the association between laryngeal penetration and aspiration pneumonia.

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Predicting penetration–aspiration through quantitative swallow measures of children: a videofluoroscopic study

Cited by 14 publications

References 49 publications

Risk of Aspiration Increased by Post‐swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Risk of Aspiration Increased by Post‐swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Findings of a videofluoroscopic swallowing study in patients with dysphagia

Laryngeal Penetration and Risk of Aspiration Pneumonia in Children with Dysphagia—A Systematic Review

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