The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study

Abstract

Contrary to clinical experience, clinical swallow tests are predominantly performed using water (water swallow tests, WST). In this study, we examine whether swallow tests performed using a bolus of semisolid food (bolus swallow test, BST) offer benefits. In a prospective, randomised, blind study, the results of a standardised saliva swallow test (SST), WST, BST, combinations of these tests and an endoscopic swallow test (FEES) in patients with oropharyngeal swallowing disorders of neurological (NEU) and non-neurological (NNEU) origin were compared. Sensitivity, specificity, test accuracy and inter-rater reliability were analysed. 62 patients (mean age = 64.68; range = 22–84) were included in the study (NEU = 40; NNEU = 22). A sensitivity of 70.7% (NEU = 70.3%, NNEU = 71.4%) and specificity of 82.5% (NEU = 92.3%; NNEU = 100%) were determined for the WST. The BST + SST was found to have a sensitivity of 89.6% (NEU = 66.7%; NNEU = 90.9%) and a specificity of 72.7% (NEU = 87.5%; NNEU = 90.9%). Analysis of test accuracy showed a statistically significant correlation between FEES and BST + SST. Only BST + SST exhibited statistically significant inter-rater reliability. BST in combination with SST was the sensitive clinical instrument for detecting aspiration both over the patient population as a whole and over the two sub-populations. Inter-rater reliability was found to be statistically significant. The results presented here demonstrate the benefit of semisolid food in investigating clinical dysphagia.

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

“…The results observed in this study reinforce the findings in the literature (14,19) . In addition to swallowing disorders occurring more frequently among patients older than 60 years (69.0%), a higher incidence of stroke was observed among women, with 52.4% of the cases.…”

“…From the evaluation of the swallowing process conducted using the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults (11)(12)(13)(14) , 40.5% of the cases presented severe dysphagia, confirming results observed in other studies that show a high incidence of OD post stroke, with especially high incidence in the moderate and severe cases of stroke (16,23,(25)(26)(27) . In a previous study, of the 212 stroke patients, 134 (63%) presented OD, with OD classified as mild in 26 patients (19%), moderate in 51 (38%), and severe in 57 (43%) (23) .…”

“…In the evaluation of the swallowing process, 17 cases (40.5%) presented severe dysphagia according to the Protocol for Investigation of Oropharyngeal Dysphagia in Adults (11)(12)(13)(14) .…”

“…Cerebrovascular disease is the main cause of death in Brazil and it occurs at a greater rate in people over 60 years old; the risk of stroke rises around this age and doubles at every following decade (14,18) . The results observed in this study reinforce the findings in the literature (14,19) .…”

“…Clinical evaluation of the swallowing process was then performed through the application of the Protocol for Investigation of Oropharyngeal Dysphagia in Adults (11)(12)(13)(14) . The assessment consisted in the evaluation of the orofacial myofunctional system, verification of structure strength and mobility, lower airway protection mechanisms, presence of vocal alterations, and the patient's state of awareness.…”