Image-based Measurement of Post-Swallow Residue: The Normalized Residue Ratio Scale

Pearson, William G.; Molfenter, Sonja M.; Smith, Zachary M.; Steele, Catriona M.

doi:10.1007/s00455-012-9426-9

Cited by 144 publications

(111 citation statements)

References 25 publications

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“…To assess CMA more accurately, further research using electrophysiological approach such as electromyographyis necessary [31]. PSR was measured subjectively in our current study, utilizing the normalized residue ratio scale would provide an objective way of measuring residue in the pyriform sinus [32]. This study used pre-and post-treatment design, which cannot completely exclude the possibility of spontaneous recovery.…”

Section: Discussionmentioning

confidence: 99%

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Ding¹

2017

OHNS

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ObjectiveTo evaluate the effect of balloon dilatation in treating pyriform sinus residue caused by various swallow physiology changes from different medical diagnoses. Study designMedical records of 12 in-patients with moderate to severe pyriform sinus residue were retrospectively reviewed. MethodsAll patients were examined with fiberoptic endoscopic evaluation of swallowing and video fluoroscopic swallowing assessment. The diagnoses of the 12 patients included infarction, nasopharyngeal carcinoma post-radiation, oral cancer post partial glossectomy, and motor neuron disease. All 12 patients underwent balloon dilatation.Each session lasted 30 minutes, with eight dilatations per session, three sessions per week for two weeks. ResultsThere was significant reduction in pharyngeal residue pre-versus post-balloon dilatation (p=0.002). There were also significant improvements in cricopharyngeal muscle achalasia (p=0.004) and weak pharyngeal contraction (p=0.008) pre-versus post-treatment. Eight out of the 12 patients made significant progress toward oral feeding (66.67%). ConclusionOur study found cricopharyngeal muscle achalasia and weak pharyngeal contraction were closely related to pyriform sinus residue in pharyngeal dysphagia. Balloon dilatation eliminated cricopharyngeal muscle achalasia and weak pharyngeal contraction and significantly reduced pyriform sinus residue in 8 of the 12 patients. Balloon dilatation seems to have no effect on the reduction of pyriform sinus residue when the cause was either from discoordination of swallowing subsystems in the case of infarction of the left pontocerebellar trigone or loss of large bulk of tongue tissue in the case of cancer treatment.

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Section: Discussionmentioning

confidence: 99%

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Ding¹

2017

OHNS

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“…Pharyngeal residue has also been reported to be the most important VFSS variable in reflecting pharyngeal pressure measurements in both diseased and healthy participants 33. To measure pharyngeal residue more precisely, the Normalized Residue Ratio Scale, using image analysis software, was recently proposed 34. We trained evaluators to keep high concordance rate, but an automated measurement system may become a better option in the future to minimize subjective measurement.…”

Section: Discussionmentioning

confidence: 99%

Swallowing markers in spinal and bulbar muscular atrophy

Banno

Katsuno

Suzuki

et al. 2017

Ann Clin Transl Neurol

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ObjectiveWe examined the characteristics of dysphagia in spinal and bulbar muscular atrophy, a hereditary neuromuscular disease causing weakness of limb, facial, and oropharyngeal muscles via a videofluoroscopic swallowing study, and investigated the plausibility of using these outcome measures for quantitative analysis.MethodsA videofluoroscopic swallowing study was performed on 111 consecutive patients with genetically confirmed spinal and bulbar muscular atrophy and 53 age‐ and sex‐matched healthy controls. Swallowing of 3‐mL liquid barium was analyzed by the Logemann's Videofluorographic Examination of Swallowing worksheet.ResultsOf more than 40 radiographic findings, the most pertinent abnormal findings in patients with spinal and bulbar muscular atrophy, included vallecular residue after swallow (residue just behind the tongue base), nasal penetration, and insufficient tongue movement (P < 0.001 for each) compared with healthy controls. Quantitative analyses showed that pharyngeal residue after initial swallowing, oral residue after initial swallowing, multiple swallowing sessions, and the penetration–aspiration scale were significantly worse in these patients (P ≤ 0.005 for each) than in controls. In patients with spinal and bulbar muscular atrophy, laryngeal penetration was observed more frequently in those without subjective dysphagia.InterpretationDysphagia of spinal and bulbar muscular atrophy was characterized by impaired tongue movement in the oral phase and nasal penetration followed by pharyngeal residues, which resulted in multiple swallowing sessions and laryngeal penetration. Although major limitations of reproducibility and radiation exposure still exist with videofluoroscopy, pharyngeal residue after initial swallowing and the penetration–aspiration scale might serve as potential outcome measures in clinical studies.

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“…Also, it does not consider possible individual anatomical differences. As described in a recent study 20 , this limitation implies that two different residue volumes could generate identical proportional values. Besides that, it is well known that the space inside the valleculae determines the amount of residue that can be stored until it reaches the limit of pooling and possible aspiration.…”

Section: Discussionmentioning

confidence: 99%

“…This approach calculates the area of a rectangle (twodimensional) and not the circumscribed area of the actual residue or space (i.e. elliptical or oval triangular shape) 20 . Also, it does not consider possible individual anatomical differences.…”

Section: Discussionmentioning

confidence: 99%

Análise videofluoroscópica bidimensional perceptual da fase faríngea da deglutição em indivíduos acima de 50 anos

Chaves

Mangilli

Sassi

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background: Videofluoroscopy is considered the "gold standard"procedure for the evaluation of swallowing by most units that treat patients with dysphagia, having a great impact in decision making, not only in therapeutic terms, but also in determining the prognosis. Aim: To propose and to verify the reproducibility of the results of a perceptual two-dimensional videofluoroscopic protocol for the analysis of the pharyngeal phase of swallowing in a population of healthy adults. Methods: Participants were 20 healthy adults, of both genders, with ages between 50 and 65 years. Videofluoroscopy was performed during the swallow of the following consistencies: 10 ml of liquid; 7 ml of paste; and half a "salt and water" biscuit. The protocol was composed by four parts: assessment of the pharyngeal transit time; assessment of the duration of the tongue base movement to the posterior pharyngeal wall; valleculae residue ratio; assessment of penetration/aspiration. Statistical analysis involved the assessment of data reproducibility between raters and analysis of the quantitative data regarding gender. Results:Comparison among raters indicated that data was highly reproducible. No significant differences were found between genders for pharyngeal transit time; for the duration of the tongue base movement to the posterior pharyngeal wall; and for the valleculae residue ratio. Conclusion: The perceptual two-dimensional videofluoroscopy analysis demonstrated to be a reproducible method. Valleculae residue was present in 40% of the study sample, suggesting that this parameter alone does not indicate alterations of the pharyngeal phase of swallowing. RESUMO -Racional:A videofluoroscopia é considerada o procedimento "padrão-ouro" para avaliação da deglutição pela maioria das unidades que atendem pacientes com disfagia, tendo grande impacto na tomada de decisão, não só em termos terapêuticos, como também na determinação do prognóstico. Objetivo: Propor e verificar a reprodutibilidade de protocolo de análise videofluoroscopica bidimensional perceptual da fase faríngea da deglutição em uma população de adultos saudáveis. Métodos: Participaram desta pesquisa 20 indivíduos saudáveis, de ambos os gêneros, com idades entre 50 e 65 anos. O exame foi realizado durante a ingestão de "alimentos" com as seguintes consistências: 10 ml de líquido; 7 ml de pastoso; e meio biscoito do tipo "água e sal". O protocolo proposto foi composto de quatro partes: avaliação do tempo de trânsito faríngeo; avaliação da duração do contato da base de língua na parede posterior da faringe; avaliação da porcentagem de resíduo alimentar em valécula; avaliação de penetração e aspiração na árvore respiratória. A análise estatística envolveu a avaliação da reprodutibilidade do método de análise entre avaliadores e a análise dos dados quantitativos, levando-se em consideração os gêneros. Resultados: Pela análise comparativa entre os avaliadores houve alta reprodutibilidade. Não foram encontradas diferenças estatisticamente significantes para o tempo de trâns...

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Image-based Measurement of Post-Swallow Residue: The Normalized Residue Ratio Scale

Cited by 144 publications

References 25 publications

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Swallowing markers in spinal and bulbar muscular atrophy

Análise videofluoroscópica bidimensional perceptual da fase faríngea da deglutição em indivíduos acima de 50 anos

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