Correlations between bedside and instrumental endoscopic parameters in determining severity of dysphagia: an integrated clinical evaluation of safety and efficiency

Abstract

SUMMARY Interaction between bedside and endoscopic parameters is of great interest in the management of patients with swallowing disorders. Our aim is to document if and how bedside parameters correlate with severity using endoscopic assessment. 556 consecutive patients (318 M/238 F, mean age 65.56 ± 10.36 years, range 18-91), were evaluated in our Swallowing Centre during 2008. All underwent bedside evaluation and fiberoptic endoscopic evaluation of swallowing (FEES), considering the pooling score (p-score) and the pooling sensation, collaboration and age score (p-SCA score) to express criteria of clinical severity of dysphagia. The correlation between the two tests (Spearman correlation coefficient) and their agreement to classify severity (Cohen’s kappa) was defined. After dichotomisation (cut-off: no risk/any kind of risk of aspiration), values of sensitivity and specificity were obtained after comparison with FEES results (gold standard). A close and significant correlation between the p-score and p-SCA score was found (rho = 0.88; p < 0.001). The agreement among scores in attributing the categories of risk is moderate (Cohen’s Kappa = 0.46; p < 0.001).The p-score had a sensitivity of 96% and specificity of 60%, while the p-SCA score has a sensitivity of 98% and specificity of 40%. Our results suggest that including even a few parameter from bedside evaluation to an endoscopic score, the level of severity expressed by the latter, decreases. The evaluation of patients with swallowing disorders should consider as many elements as possible, deriving from non-instrumental and instrumental evaluation (integrated clinical evaluation).

Tinnitus and Subjective Hearing Loss are More Common in Migraine: A Cross-Sectional NHANES Analysis

“…In addition to subjective-HL, tinnitus was also independently associated with migraine in the studied cohort. The high prevalence of tinnitus in different types of migraine has been previously reported (5,31,32). Tinnitus can also worsen in intensity with migraine episodes (33,34), or only appear as a concurrent symptom and subside after the headache (18).…”

Vestibular and auditory manifestations of migraine

“…Tinnitus may be associated with a migraine phenomenon, as both are similarly elusive in etiology but possibly share a pathophysiology linked by the central nervous system, specifically the activation of the trigeminal nerve and likely central hypersensitivity [25,26]. Tinnitus has been reported to be more prevalent in different types of migraine [27][28][29]. Pulsatile tinnitus is another symptom which can be seen in the context of migraine and may be resolved with migraine treatment with avoidance of dietary triggers with or without medication [30].…”

Assessment of radio(chemo)therapy-related dysphagia in head and neck cancer patients based on cough-related acoustic features: a prospective phase II national clinical trial (ACCOUGH-P/A trial)

“…YPRS scoring will be carried out before the start of the trials and after each swallowing trial. The number of required dry swallows to clear pooling (pre-swallow secretions and post-swallow food residue) will be counted (< 2, between 2 and 5, > 5), and their efficacy will be verified [ 13 ].…”

“…A voluntary throat clearing—a manoeuver that clears the pharynx and larynx from pooling (pre-swallow secretions and post-swallow food residue)—differs from a voluntary cough as it is produced without any prior inspiration and requires partial vocal fold closure only [ 10 , 11 ]. Pooling is regarded as a clinical predictor of prandial P/A in the lower respiratory tract [ 12 – 14 ], so efficient coughing, throat clearing and dry swallowing are considered as crucial spontaneous or voluntary defensive strategies to clear the airway [ 13 ]. A reflexive cough is stimulated by a biological need to protect the airways and is triggered via direct activation of receptors on airway sensory nerves (vagus nerves) by mechanical and/or chemical stimuli [ 11 , 15 , 16 ] to the brainstem, bypassing cortical control completely [ 17 ].…”