Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

Labeit, Bendix; Mueller, Hanna Weyler; Muhle, Paul; Claus, Inga; Warnecke, Tobias; Dziewas, Rainer; Suntrup‐Krueger, Sonja

doi:10.1159/000493371

Cited by 26 publications

(38 citation statements)

References 31 publications

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“…Here, myositis-related dysphagia differs from other forms of neurogenic dysphagia, such as stroke-related dysphagia, which correlates with general stroke symptoms and severity. 18 However, in contrast to the results of this study, there are other studies suggesting that dysphagia is associated with certain clinical parameters, for example, that the prevalence of dysphagia in inclusion body myositis is particularly high compared to other forms of IIM. 13 The association of dysphagia severity with pneumonia is in line with the results of previous studies 4,5,9,19,20 and underlines both the clinical relevance of dysphagia and the validity of FEES findings.…”

Section: Discussioncontrasting

confidence: 99%

“…Thus, the extent of general muscle weakness and the disease duration do not seem to provide information on swallowing function, so that dysphagia must be considered independently of these factors. Here, myositis‐related dysphagia differs from other forms of neurogenic dysphagia, such as stroke‐related dysphagia, which correlates with general stroke symptoms and severity 18 . However, in contrast to the results of this study, there are other studies suggesting that dysphagia is associated with certain clinical parameters, for example, that the prevalence of dysphagia in inclusion body myositis is particularly high compared to other forms of IIM 13 …”

Section: Discussioncontrasting

confidence: 85%

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Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Labeit¹,

Perlova²,

Pawlitzki³

et al. 2021

Muscle and Nerve

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Introduction: Oropharyngeal dysphagia is a clinical hallmark of idiopathic inflammatory myopathy (IIM). This study investigated predictors, outcome, and characteristics of oropharyngeal dysphagia in patients with different types of IIM.Methods: Flexible endoscopic evaluation of swallowing (FEES) videos of 71 IIM patients were retrospectively analyzed for bolus spillage, penetration, aspiration, and pharyngeal residue. Based on these findings, dysphagia severity was rated. Regression analyses were performed to investigate demographic and disease-specific predictors of dysphagia severity and pneumonia as outcome-relevant complications of dysphagia. A score was developed to rate the quality of the endoscopic white-out as a surrogate marker for pharyngeal muscle weakness with consecutive residue.Results: Our analysis revealed no independent predictors of dysphagia severity. Dysphagia severity, however, was an independent predictor for pneumonia, which occurred in 24% of patients. Pharyngeal residue with risk of postdeglutitive aspiration was the most common dysphagia pattern. Attenuation of the endoscopic whiteout was related to residue severity. Discussion: Dysphagia in IIM assessed with FEES is associated with relevant complications, such as aspiration pneumonia, and must be considered independently of peripheral muscle weakness and disease duration. Swallowing impairment mainly presents with pharyngeal residue. The quality of the white-out may serve as a semiquantitative surrogate marker for pharyngeal contractility.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 85%

Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Labeit¹,

Perlova²,

Pawlitzki³

et al. 2021

Muscle and Nerve

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“…Neurogenic dysphagia represents an enormous burden for patients, health care professionals, and society. It is highly prevalent in most neurologic diseases such as stroke, 1,2 Parkinson disease (PD), 3 dementia, 4,5 amyotrophic lateral sclerosis (ALS), 6 and neuromuscular disorders, for example, myositis 7 and myasthenia gravis. 8 Dysphagia can lead to severe complications and cause malnutrition, dehydration, and aspiration pneumonia.…”

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confidence: 99%

Neurogenic Dysphagia

et al. 2021

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Objective:Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).Methods:A systematic literature review was conducted, searching MEDLINE from inception to 05/2020 for FEES findings in neurological diseases of interest. Based on a retrospective analysis of FEES-videos in neurological diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1012 randomly selected FEES-videos of patients with various neurological disorders. Chi-square-tests were used to compare the distribution of dysphagia phenotypes between the underlying neurological disorders.Results:159 articles were identified of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) “Premature bolus spillage” and (2) “delayed swallowing reflex” occurred mainly in stroke patients, (3) “predominance of residue in the valleculae” was most common in Parkinson's disease, (4) “predominance of residue in the piriform sinus” occurred only in myositis, motoneuron disease and brainstem stroke patients, (5) “pharyngolaryngeal movement disorder” was found in atypical Parkinsonian syndromes and stroke patients, (6) “fatigable swallowing weakness” was common in patients with myasthenia gravis, and (7) “complex disorder” with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic later sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).Conclusion:Neurogenic dysphagia is not a mere symptom, but a multi-etiological syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.

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“…In geriatric patient populations, oropharyngeal dysphagia is highly prevalent, especially in patients with stroke, Alzheimer's disease and related disorders. 1,3,41 In our study population, these patient groups are less frequently represented. This is due to organizational reasons, as only patients in whom videofluoroscopy was performed for diagnostic reasons were included, so the disease distribution is not representative.…”

Section: Discussionmentioning

confidence: 96%

“…This is due to organizational reasons, as only patients in whom videofluoroscopy was performed for diagnostic reasons were included, so the disease distribution is not representative. However, penetrations and aspirations are also common in these disorders, 3,41 and pharyngeal residue, especially in the valleculae, are a common, transdiagnostic manifestation of neurogenic dysphagia. 1 Unlike otolaryngologic disorders, neurogenic dysphagia does not present with systematic, structural abnormalities in the oropharynx that could affect visual conditions in diagnostic modalities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

Labeit¹,

Ahring

Boehmer

et al. 2022

Journal of the American Medical Directors Association

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Objective: In the evaluation of oropharyngeal dysphagia, instrumental procedures, for example, flexible endoscopic evaluation of swallowing or videofluoroscopic swallowing study, are essential to improve diagnostic accuracy for salient findings such as penetration, aspiration, or pharyngeal residue. To date, it is unclear which of the 2 methods represents the diagnostic gold standard. The aim of this study, therefore, was to compare videofluoroscopy and swallowing endoscopy during a simultaneous swallowing examination in a large cohort of patients with oropharyngeal dysphagia. Designs: Prospective observational study. Setting and participants: In this study, 49 patients with oropharyngeal dysphagia (mean age 70.0 AE 10.8 years) were evaluated using simultaneous swallowing endoscopy and videofluoroscopy. Furthermore, the effect of narrow-band imaging in swallowing endoscopy on the assessment of penetration and aspiration was investigated in a subgroup of 19 patients. Measures: The Penetration-Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale were rated independently based on both modalities. Results: Both modalities showed a high correlation between penetration, aspiration, and pharyngeal residue. Causes for a higher score on the Penetration-Aspiration Scale in videofluoroscopy were intradeglutitive events that were not visible in swallowing endoscopy or false-positive events because of the loss of the lateral dimension in videofluoroscopy. A typical reason for a higher score on this scale in swallowing endoscopy was the better visualization of the anatomical structures. Narrow-band imaging in swallowing endoscopy resulted in a higher score on the Penetration-Aspiration Scale for liquids and semisolids in individual cases, although overall there was no statistically significant difference between scores using white light or narrow-band imaging. Conclusions and Implications: Videofluoroscopy and swallowing endoscopy may equally be considered as a diagnostic gold standard for oropharyngeal dysphagia regarding penetration, aspiration, and pharyngeal residue. Narrow-band imaging may increase the sensitivity for penetration and aspiration in individual cases.

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Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

Cited by 26 publications

References 31 publications

Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy

Neurogenic Dysphagia

Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

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