Clinical and videofluoroscopic evaluation of swallowing disorders.

Ott, David J.; Pikna, Leigh Ann

doi:10.2214/ajr.161.3.8352094

Cited by 53 publications

(40 citation statements)

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“…The clinical and videofluoroscopic assessment criteria for the presence and severity of dysphagia and aspiration were developed by ourselves and influenced by the work of Ott and Pikna [24], Linden and Siebens [25]and Logemann [26]. The assessment is typical of that adopted by speech pathologists and swallowing researchers.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy

Mann

Hankey²,

Cameron³

2000

Cerebrovasc Dis

327

215

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We prospectively examined 128 patients with acute first-ever stroke to determine the prevalence of swallowing disorders, the diagnostic accuracy of our clinical assessment of swallowing function compared with videofluoroscopy, and interobserver agreement for the clinical and videofluoroscopic diagnosis of swallowing disorders and aspiration. We found clinical and videofluoroscopic evidence of a swallowing disorder in 51% [95% confidence interval (CI) 42–60%] and 64% (95% CI 55–72%) of patients, respectively, and aspiration in 49% (95% CI 40–58%) and 22% (95% CI 15–29%) of patients, respectively. The optimal clinical criteria for detecting videofluoroscopic evidence of a swallowing disorder and aspiration were any clinical evidence of a swallowing disorder (sensitivity 73%, 95% CI 62–82%; specificity 89%, 95% CI 76–96%), and any clinical evidence of aspiration (sensitivity 93%, 95% CI 76–99%; specificity 63%, 95% CI 53–72%). The interobserver agreement between two speech pathologists for the clinical diagnosis of a swallowing disorder (κ: 0.82 ± 0.09) and aspiration (κ: 0.75 ± 0.09) was good, and between a speech pathologist and radiologist for the videofluoroscopic diagnosis of a swallowing disorder (κ: 0.75 ± 0.09) and aspiration (κ: 0.41 ± 0.09), it was good and fair, respectively. Although clinical bedside examination underestimates the frequency of swallowing abnormalities and overestimates the frequency of aspiration compared with videofluoroscopy, it may still offer valuable information for the diagnosis of swallowing impairment. Long-term follow-up studies are required to determine the independent functional significance of the findings of the bedside and videofluoroscopic examinations in predicting the occurrence of important outcome events such as aspiration pneumonia.

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Section: Discussionmentioning

confidence: 99%

Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy

Mann

Hankey²,

Cameron³

2000

Cerebrovasc Dis

327

215

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“…The clinical and videofluoroscopic assessment and diagnostic criteria for the presence and severity of a swallowing disorder and aspiration were developed by us and influenced by the work of Ott and Pikna, 14 Linden and Siebens, 15 and Logemann. 16 Briefly, the clinical assessment of swallowing function was conducted by 2 speech pathologists independent of each other and blinded to the videofluoroscopic and CT brain scan findings.…”

Section: Methodsmentioning

confidence: 99%

Swallowing Function After Stroke

Mann

Hankey

Cameron

1999

Stroke

673

175

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Background and Purpose-Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after acute stroke and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications. Methods-We prospectively assembled an inception cohort of 128 hospital-referred patients with acute first stroke. We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of stroke onset, using standardized methods and diagnostic criteria. All patients were followed up prospectively for 6 months for the occurrence of death, recurrent stroke, chest infection, recovery of swallowing function, and return to normal diet. Results-At presentation, a swallowing abnormality was detected clinically in 65 patients (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 patients (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 patients (20%; 95% CI, 14% to 28%) suffered a chest infection. At 6 months after stroke, 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 patients (50%; 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 patients who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 patients and aspiration in another 17. The single independent baseline predictor of chest infection during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, chest infection, or aspiration at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the laryngeal vestibule, age Ͼ70 years, and male sex. Conclusions-Swallowing function should be assessed in all acute stroke patients because swallowing dysfunction is common, it persists in many patients, and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing abnormalities and complications are videofluoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies. (Stroke. 1999;30:744-748.)

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“…All images were acquired with an spoiled gradientrecalled echo (SPGR) sequence in the midsagittal plane of the pharyngeal cavity with the following acquisition parameters: a repetition time (TR) of 14.2 msec, an echo time (TE) of 6.7 msec, a flip angle of 90°, a matrix of 256 ϫ 256, a field of view (FOV) of 30 ϫ 30 cm 2 , and a slice thickness of 10 mm. The slice thickness was found in our preliminary study to be most suitable for clearly observing the motion of the posterior pharyngeal wall during swallowing.…”

Section: Imagingmentioning

confidence: 99%

“…This method is widely accepted as the "gold standard" for diagnosing dysphagia and assessing food in terms of ease of swallowing (2). Palmer et al (3) reported that videofluorography effectively visualizes the motion of the posterior pharyngeal wall, which is critical in the swallowing of liquid.…”

mentioning

confidence: 99%

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

Honda

Hata

2007

Magnetic Resonance Imaging

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Purpose:To assess the feasibility of dynamic MRI of swallowing in a seated position using an open-configuration MRI scanner, and to compare its capacity for motion analysis around the pharyngeal wall with that of videofluorography. Materials and Methods:Six healthy individuals (four women and two men, mean age ϭ 31.4 Ϯ 7.5 years) were examined with an open-configuration MRI system using a fast spoiled gradient-recalled echo (SPGR) sequence. Dynamic imaging was performed while the subjects were in a seated position after they swallowed oral contrast medium from a cup. An oral and maxillofacial radiologist measured the motion of six structures: the hyoid bone (HB), larynx (LX), upper oropharynx (UOP), lower oropharynx (LOP), pharyngoesophageal segment (PES) behind the vocal folds, and upper esophagus (ESO). The measured motions were compared with reported values from videofluorography-based observations. Results:Open-configuration MRI depicted the anatomic structures related to swallowing (lip, tongue, soft palate, mandible, pharynx, HB, LX, and PES), and the course of the mylohyoid muscle (MM). The vertical and anteroposterior displacements of these structures did not differ significantly from those measured by videofluorography. Conclusion:Dynamic imaging of swallowing using openconfiguration MRI provides image information comparable to that obtained from videofluorography.

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Clinical and videofluoroscopic evaluation of swallowing disorders.

Cited by 53 publications

References 0 publications

Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy

Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy

Swallowing Function After Stroke

Dynamic imaging of swallowing in a seated position using open‐configuration MRI

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