The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration

Abstract

This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and swallowing frequency in the prediction of aspiration of food and liquid. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed on a total of 69 individuals that included hospitalized elderly, nonhospitalized elderly, and young normal subjects. A four-level rating scale for determining the severity of accumulated oropharyngeal secretions was developed and employed to rate subjects prior to the presentation of food or liquid during the FEES. Spontaneous dry swallows were also counted during the observation period of the FEES. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of aspiration of food or liquid. There were significantly fewer spontaneous swallows in hospitalized subjects when compared with nonhospitalized subjects. There was also a significant decrease in the frequency of spontaneous swallows in aspirating hospitalized subjects when compared with nonaspirating hospitalized subjects. Results are discussed in terms of integrating this information with clinical bedside examination techniques.

Detecting pharyngeal post-swallow residue by ultrasound examination: a case series.

“…The pharyngeal post-swallow residue is the presence of food or liquid in the hypopharynx that is not entirely eliminated by swallowing [4]. The pharyngeal post-swallow residue is a predictor of aspiration that causes aspiration pneumonia because the residue suggests impairment of the driving forces of the oropharyngeal bolus and reduced swallowing efficiency [5].…”

“…Clinicians usually perform a videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) to assess pharyngeal post-swallow residue [4,7]. With VFSS, the pharyngeal residue is visualized as a shadow in the hypopharynx after the participant swallows a contrast agent such as barium sulfate.…”

Otolaryngology and speech therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal

“…We observed: mechanical obstructions, tongue movement changes, glottic closure changes, salivary stasis in the oral cavity, pharynx and larynx, overt salivary aspiration or overt involvement of the local sensitivity. We could stop the assessment at any time, without exposing the patient to the risk of aspiration of the dye food samples 10,[22][23][24] . during the functional assessment of deglutition by dVe, it was possible to obtain further details on the pharyngeal phase of deglutition, which corresponds to the intersection phase between the airways and digestive tract, where the intactness of the protective mechanisms of the airways is paramount to prevent aspiration.…”

Schematization of katilmis technique for Vocal cord lateralization: how we do it?

“…[8] The scale score ranged from 0 (normal) to 3 (pooling in laryngeal vestibule consistently). Level 1 indicated secretions evident in the vallecular space or pyriform sinuses.…”