Screening Test for Silent Aspiration at the Bedside

Abstract

Many screening tests for dysphagia can be given at bedside. However, they cannot accurately screen for silent aspiration (SA). We studied the usefulness of a cough test to screen for SA and combined it with the modified water swallowing test (MWST) to make an accurate screening system. Patients suspected of dysphagia (N = 204) were administered a cough test and underwent videofluorography (VF) or videoendoscopy (VE). Sensitivity of the cough test for detection of SA was 0.87 with specificity of 0.89. Of these 204 patients, 107 were also administered the MWST. Fifty-five were evaluated as normal by the screening system, 49 of whom were evaluated as normal by VF or VE. Sixteen were evaluated as "SA suspected" by the screening system; seven of them were normal, and seven were evaluated as having SA by VF or VE. Nineteen were evaluated as aspirating with cough, 14 of whom had aspiration with cough as shown by VF or VE. Seventeen were evaluated as having SA, 15 of whom had SA shown by VF or VE. The cough test was useful in screening for SA. Moreover, a screening system that included MWST and a cough test could accurately distinguish between the healthy who were safe in swallowing and SA patients who were unsafe.

Avaliação videofluoroscópica da mastigação e deglutição em indivíduos com disfunção temporomandibular (DTM)

“…The clinical history must also investigate episodes of pneumonia, which may be associated with tracheal aspiration 14 . This study enabled a qualitative analysis of deglutition by means of an exam which does not require additional resources.…”

Voluntary and reflex cough and the expiration reflex; implications for aspiration after stroke

“…But there is a teleological disadvantage to RC; like VC it starts with an inspiration, so is a form of 'pro-aspiration reflex'. RC is usually tested by making the patient inhale, either during tidal breathing or with deep voluntary breaths, an aerosol of a tussogenic agent such as capsaicin, citric or tartaric acids or distilled water [10][11][12][26][27][28][29]. Usually the concentrations are increased until the patient gives two coughs (C2-'threshold') and then five coughs (C5-'sensitivity'), and the results are usually determined subjectively, although objective methods have also been used [10][11][12].…”

“…Assessment of RC has been applied to stroke patients [10,[27][28][29]; it involves rather cumbersome apparatus (including a face mask and aerosol administration apparatus) that may interfere with patient assessment or treatment; and it may give no M A N U S C R I P T…”

“…Several studies have compared VC and RC in assessing the risk of aspiration or pneumonia [10,[27][28][29]. In general both were shown to be depressed after M A N U S C R I P T…”

Achados da videoendoscopia da deglutição em adultos com disfagia orofaríngea neurogênica

“…Os métodos mais utilizados para o diagnóstico das disfagias são a avaliação clínica e os exames objetivos, como a videoendoscopia e a videofluoroscopia da deglutição (8)(9) . A videoendoscopia da deglutição (VED) apresenta resultados comparáveis à videofluoroscopia (10) , sendo um método de fácil realização, baixo custo, sem exposição à radiação, podendo ser realizado ao lado do leito do paciente; não oferece riscos ao indivíduo, na maioria dos casos, podendo ser repetido diversas vezes para a observação do sucesso da terapia fonoaudiológica (11) .…”