Accuracy of cervical auscultation in detecting the presence of material in the airway

Abstract

Several studies have investigated the accuracy of cervical auscultation (CA). However, both the sensitivities and the specificities of CA in detecting dysphagic conditions varied widely among these studies. These wide variations of the accuracy of CA might be caused by differences of the targeted sounds, such as the expiratory sound (ES) and/or swallowing sound (SS). Forty‐six dysphagic patients were served as subjects. Patients who had unoccluded tracheostoma and patients who could not follow the instructions were excluded. During the videofluorographic swallowing study (VFSS), the subjects swallowed 3 ml of yogurt containing barium sulfate. The VFSS images were recorded with acoustic signals including both the swallowing and respiratory sounds detected by our method. Classification of the VFSS images was decided by consensus of the three dentists using a penetration‐aspiration scale (PAS). Recorded VFSS images were classified into the following 2 groups based on PAS: “no or minimum risk group”: PAS1–2; and “possible risk group”: PAS3–8. As a result of the classification of VFSS findings, 30 samples were evaluated as no or minimum risk group and 16 as possible risk group. Twelve observers including 10 dentists other than 3 dentists who evaluated VFSS images and 2 speech pathologists auditorily diagnosed “negative” and “positive.” Sensitivity, specificity, and intra‐rater reliability was calculated for the 3 types of acoustic samples. The sensitivity of the intra‐rater reliability was 60.3% for ES, 76.6% for SS, and 89.9% for ES + SS. The sensitivity of intra‐rater reliability of ES + SS samples was significantly higher than that of ES (p < .01) and SS (p < .05). The sensitivity of intra‐rater reliability of SS was significantly higher than that of ES (p < .01). The specificity of the intra‐rater reliability was 53.7% for ES, 50.3% for SS, and 44.5% for ES + SS. ES + SS might be most useful for detecting the presence of material in the airway.

Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?

“…Instrumental investigations provide specific point-in-time diagnostic information of visual observations of penetration, aspiration and pathophysiological causes for dysphagia which underpins effective rehabilitation (Swan et al, 2019). CA provides acoustic information regarding swallow-respiratory coordination not clearly captured in VFFS or FEES (Frakking et al, 2017;Nozue et al, 2017;Yamashita et al, 2014). The CSE/review þ CA compliments holistic and person-centred care by providing opportunity for regular review of patient/ dysphagia progression and management adaptation, rather than just a snapshot of a swallow assessment.…”

“…Cervical auscultation (CA) is an adjunct to the clinical swallow evaluation and may use a stethoscope, microphone or accelerometer to listen to and interpret swallow-respiratory sounds and coordination, in paediatric and adult populations (Almeida, Ferlin, Parente, & Goldani, 2008;Borr, Hielscher-Fastabend, & Lucking, 2007;Cichero & Murdoch, 2002;Frakking, Chang, David, Orbell-Smith, & Weir, 2019;Frakking, Chang, O'Grady, David, & Weir, 2017;Lagarde, Kamalski, & van Den Engel-Hoek, 2016;Leslie, Drinnan, Finn, Ford, & Wilson, 2004;Morini ere, Boiron, Alison, Makris, & Beutter, 2008;Nozue et al, 2017;Stroud, Lawrie, & Wiles, 2002;Youmans & Stierwalt, 2011). Auscultation is regularly used in cardiac and respiratory medicine.…”

Assessment of cough in head and neck cancer patients at risk for dysphagia—An overview

“…100,[103][104][105] Due to its inaccuracy, research has demonstrated the risk of using CA as a stand-alone tool for assessing dysphagia. 97,101,103,104,[106][107][108][109] Comparing healthy swallows and penetration-aspiration swallows with a tri-axial accelerometer, Sejdic et al showed that each axis (three anatomical directions) reported distinct information. 97 This finding suggests that the position and orientation of a sensor influence the recorded signal.…”

“… 100 , 103 , 104 , 105 Due to its inaccuracy, research has demonstrated the risk of using CA as a stand‐alone tool for assessing dysphagia. 97 , 101 , 103 , 104 , 106 , 107 , 108 , 109 …”

Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematic review and meta‐analysis

“…Several physical assessments and screening tests are available to identify high‐risk patients with aspiration and pharyngeal residue (Bours, Speyer, Lemmens, Limburg, & de Wit, 2009). For example, physical assessments based on neurological findings (Toscano et al, 2019), the Repetitive Saliva Swallowing Test (Oguchi et al, 2000; Oguchi, Saito, Baba, Tanaka, & Onogi, 2000), the Modified Water Swallowing Test (Osawa, Maejima, & Tanahashi, 2012), the Food Test (Tohara, Saitoh, Mays, Kuhlemeier, & Palmer, 2003), and cervical auscultation (Nozue et al, 2017) are often performed to assess aspiration and pharyngeal residue. These methods can be applied to not only patients with dysphagia in hospitals but also in nursing homes and home care settings.…”