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Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

Published online by Cambridge University Press:  10 June 2021

R Hanna  and
D R Randall
R Hanna
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Canada
D R Randall*
Affiliation:
Section of Otolaryngology – Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada Outpatient Dysphagia Clinic, Peter Lougheed Centre, Calgary, Canada
*
Author for correspondence: Dr Derrick R Randall, Section of Otolaryngology – Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, Suite 262–1632, 14th Ave NW, CalgaryT2N 1M7, Canada E-mail: d.randall@ucalgary.ca Fax: +1 403 282 0059
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Abstract

Objective

Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time.

Method

This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities.

Results

This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88).

Conclusion

Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

Keywords

Deglutition DisordersFluoroscopyPneumoniaAspiration
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 7 , July 2021 , pp. 593 - 598
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr D R Randall takes responsibility for the integrity of the content of the paper

Presented at the Canadian Society of Otolaryngology–Head and Neck Surgery annual meeting, 1–4 June 2019, Edmonton, Canada.

References

McClave, SA, DeMeo, MT, DeLegge, MH, DiSario, JA, Heyland, DK, Maloney, JP et al. North American Summit on Aspiration in the Critically Ill Patient: consensus statement. J Parenter Enteral Nutr 2002;26(suppl 6):S80–5CrossRefGoogle ScholarPubMed
Chadwick, DD, Jolliffe, J. A descriptive investigation of dysphagia in adults with intellectual disabilities. J Intellect Disabil Res 2009;53:29–43CrossRefGoogle ScholarPubMed
Cho, SY, Choung, RS, Saito, YA, Schleck, CD, Zinsmeister, AR, Locke, GR et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil 2015;27:212–19CrossRefGoogle ScholarPubMed
Bhattacharyya, N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg 2014;151:765–9CrossRefGoogle ScholarPubMed
Martino, R, Foley, N, Bhogal, S, Diamant, N, Speechley, M, Teasell, R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36:2756–63CrossRefGoogle ScholarPubMed
Cichero, JAY, Altman, KW. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr Inst Workshop Ser 2012;72:1–11CrossRefGoogle ScholarPubMed
Via, MA, Mechanick, JI. Malnutrition, dehydration, and ancillary feeding options in dysphagia patients. Otolaryngol Clin North Am 2013;46:1059–71CrossRefGoogle ScholarPubMed
Sellars, C, Bowie, L, Bagg, J, Sweeney, MP, Miller, H, Tilston, J et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007;38:2284–91CrossRefGoogle ScholarPubMed
Furman, EF. Undernutrition in older adults across the continuum of care: nutritional assessment, barriers, and interventions. J Gerontol Nurs 2006;32:22–7CrossRefGoogle Scholar
Altman, KW, Yu, G-P, Schaefer, SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg 2010;136:784–9CrossRefGoogle ScholarPubMed
Plowman-Prine, EK, Sapienza, CM, Okun, MS, Pollock, SL, Jacobson, C, Wu, SS et al. The relationship between quality of life and swallowing in Parkinson's disease. Mov Disord 2009;24:1352–8CrossRefGoogle ScholarPubMed
Rosenbek, JC, Robbins, JA, Roecker, EB, Coyle, JL, Wood, JL. A penetration-aspiration scale. Dysphagia 1996;11:93–8CrossRefGoogle ScholarPubMed
Martin-Harris, B, Logemann, JA, McMahon, S, Schleicher, M, Sandidge, J. Clinical utility of the modified barium swallow. Dysphagia 2000;15:136–41CrossRefGoogle ScholarPubMed
Carnaby, G, Hankey, GJ, Pizzi, J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006;5:31–7CrossRefGoogle ScholarPubMed
Bock, JM, Varadarajan, V, Brawley, MC, Blumin, JH. Evaluation of the natural history of patients who aspirate. Laryngoscope 2017;127(suppl 8):S1–10CrossRefGoogle ScholarPubMed
Martin-Harris, B, Brodsky, MB, Michel, Y, Castell, DO, Schleicher, M, Sandidge, J et al. MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia 2008;23:392–405CrossRefGoogle ScholarPubMed
Butler, SG, Markley, L, Sanders, B, Stuart, A. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol 2015;124:480–3CrossRefGoogle ScholarPubMed
Azzopardi, N, Ellul, P. Pneumonia and mortality after percutaneous endoscopic gastrostomy insertion. Turk J Gastroenterol 2013;24:109–16CrossRefGoogle ScholarPubMed
Brown, K, Cai, C, Barreto, A, Shoemaker, P, Woellner, J, Vu, K et al. Predictors of percutaneous endoscopic gastrostomy placement in acute ischemic stroke. J Stroke Cerebrovasc Dis 2018;27:3200–7CrossRefGoogle ScholarPubMed
Pitts, T. Airway protective mechanisms. Lung 2014;192:27–31CrossRefGoogle ScholarPubMed
Altman, KW. Understanding dysphagia: a rapidly emerging problem. Otolaryngol Clin North Am 2013;46:xiii–xviCrossRefGoogle ScholarPubMed
Garcia, JM, Chambers, E, Molander, M. Thickened liquids: practice patterns of speech-language pathologists. Am J Speech Lang Pathol 2005;14:4–13CrossRefGoogle ScholarPubMed
Barbon, CEA, Steele, CM. Efficacy of thickened liquids for eliminating aspiration in head and neck cancer: a systematic review. Otolaryngol Head Neck Surg. 2015;152:211–18CrossRefGoogle ScholarPubMed