Cervical auscultation as an adjunct to the clinical swallow examination: A comparison with fibre-optic endoscopic evaluation of swallowing

Abstract

This prospective, single-blinded study investigated the validity and reliability of cervical auscultation (CA) under two conditions; (1) CA-only, using isolated swallow-sound clips, and (2) CSE + CA, using extra clinical swallow examination (CSE) information such as patient case history, oromotor assessment, and the same swallow-sound clips as condition one. The two CA conditions were compared against a fibre-optic endoscopic evaluation of swallowing (FEES) reference test. Each CA condition consisted of 18 swallows samples compiled from 12 adult patients consecutively referred to the FEES clinic. Patients' swallow sounds were simultaneously recorded during FEES via a Littmann E3200 electronic stethoscope. These 18 swallow samples were sent to 13 experienced dysphagia clinicians recruited from the UK and Australia who were blinded to the FEES results. Samples were rated in terms of (1) if dysphagic, (2) if the patient was safe on consistency trialled, and (3) dysphagia severity. Sensitivity measures ranged from 83-95%, specificity measures from 50-92% across the conditions. Intra-rater agreement ranged from 69-97% total agreement. Inter-rater reliability for dysphagia severity showed substantial agreement (rs = 0.68 and 0.74). Results show good rater reliability for CA-trained speech-language pathologists. Sensitivity and specificity for both CA conditions in this study are comparable to and often better than other well-established CSE components.

The reliability and validity of cervical auscultation in the diagnosis of dysphagia: a systematic review

“…In one study, direct observation of cervical auscultation was assessed. 20 In the other studies, an audio recording was made of the cervical auscultation sounds and analyzed afterwards. None of the studies investigated the use of cervical auscultation in infants or children.…”

“…13 In the included studies, cervical auscultation was used to assess several aspects of dysphagia. Two studies assessed whether dysphagia was present or not, 17,20 in two other studies ‘aspiration’ was assessed. 13,14 One study assessed whether the swallow was ‘normal’ or ‘abnormal’, 12 and one study assessed whether ‘pharyngeal residue’ was present.…”

“…In several studies the reliability and validity of cervical auscultation is measured. The reliability of cervical auscultation shows a wide variation among speech language therapists 20 and the validity varies widely in several studies. 12,13 The aim of this systematic review is to provide a critical overview of the studies that have assessed the reliability and validity of cervical auscultation in evaluating the pharyngeal phase of swallowing to diagnose the aspects of dysphagia in patients who suffer from dysphagia.…”

Dysphagia services in the era of COVID-19: Are speech-language therapists essential?

“…The study by Langmore et al ( 1998 ) is a good start, as it highlights how SLTs can focus on other clinical data sets of the dysphagia assessment battery when needing to make acute diagnostic decisions at the bedside. Adding other measures such as pulse oximetry and cervical auscultation as an adjunct to the CSE could also assist this decision-making process at the bedside (Bergström, Svensson, & Hartelius, 2014 ; Zhou, Salle, Daviet, Stuit, & Nguyen, 2011 ).…”

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

“…One possible reason for these wide variations among the CA studies might be caused by the differences of targeted sounds. Some studies focused on expiratory sounds (ES) pre‐ and post‐swallow (Hirano, Takahashi, Uyama, & Michi, ; Zenner, Losinski, & Mills, ), whereas others focused on swallowing sounds (SS) alone (Bergström, Svensson, & Hartelius, ; Borr, Hielscher, & Lücking, ; Leslie, Drinnan, Finn, Ford, & Wilson, ; Santamato et al, ; Stroud, Lawrie, & Wiles, ). Therefore, the sensitivity and the specificity of CA using both swallowing and respiratory sounds for detecting dysphagic conditions are still unclear.…”