Ultrasound: an emerging modality for the dysphagia assessment toolkit?

Abstract

Purpose of reviewVideofluoroscopy (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES) are established instrumental techniques to support differential diagnosis and treatment of oropharyngeal dysphagia. Whilst their value is undisputed, each tool is not without limitations. The COVID-19 pandemic has restricted access to VFSS and FEES leading clinicians to explore alternative or augmentative tools to support swallowing assessment. Ultrasound (US) is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. While US has been utilised in swallowing research for many years, its application has not translated into common clinical practice. This review presents and debates the evidence for and against use of ultrasound for clinical swallowing assessment. Recent findingsEvaluation of swallowing muscle morphometry and measurement of isolated swallowing kinematics are two primary uses of US in swallowing assessment that have been identified in the literature. Use of US to detect bolus flow, aspiration, and residues is in its early stages and needs further research.

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

“…It is not the remit of NGT methodology to benchmark ranked elements with the existing evidence base. Reviews of current evidence are readily available in the published literature [ 1 , 18 , 84 ]. The decision to combine the assessment of swallowing with laryngeal function was based on the premise that the elements required to translate this assessment tool into clinical practice for both purposes would be comparable.…”

“…The interest in US as a swallowing and laryngeal assessment tool has gathered momentum in the past 18 months [ 1 , 18 ]. This could lead to rapid application of US into clinical practice without developing the requisite evidence base and therefore compromise patient care.…”

“…The advantages offered by ultrasound for the assessment of swallowing and laryngeal function include its accessibility, portability, lack of radiation and low levels of patient invasion which make it suitable for prolonged or repeat examinations, as well as hard-to-reach patient groups [ 18 ]. Recent research exploring manual versus automatic tracking of swallowing-related movements indicates potential for more efficient analysis of US images and improved clinical utility [ 19 ].…”

“…NPT considers clinical contexts, clinicians and practices to understand the translational gap between evidence, policy and practice, and is often used in healthcare settings [ 39 , 40 ]. Prior to normalisation of US as an evidence-based clinical assessment tool, there are a broad range of topics (or items) that require further investigation [ 1 , 18 ]. Even though many such understudied US topics have been identified, there is little guidance as to which are the most important or necessary.…”

Letter to the Editor regarding “Dysphagia in non-intubated patients affected by COVID-19 infection”

“…Nevertheless, some adaptations could certainly be made using noninvasive imaging. Assessments could include methods such as ultrasound [ 5 ], which is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Ultrasound imaging could be adopted as an alternative tool for the objective assessment of swallowing.…”