The prevalence and findings of fibre‐optic endoscopic evaluation of swallowing in hospitalised patients with dysphagia

Abstract

Swallowing disorder or dysphagia is quite common in hospitalised patients. Using fibre‐optic endoscopic evaluation of swallowing (FEES) is one of the clinical standards for evaluating swallowing disorder to prevent serious consequences such as aspiration pneumonia. This study aimed to determine the prevalence and the associated risk of dysphagia in hospitalised patients by using FEES finding. We retrospectively analysed the FEES records from the patients who were screened and suspected of swallowing problems by a certified nurse of dysphagia nursing (CNDN). The FEES findings were compared between dysphagia and without dysphagia to evaluate the associated risk of dysphagia. Six‐hundred and nine FEES records were analysed. We found dysphagia 76% in patients who suspected swallowing problems by CNDN. FEES was assessed after the subjects had been admitted for 22 days on average. There was no difference in age between dysphagia and without dysphagia participants. However, the advanced age (age > 85 years old) increased the odd of dysphagia 1.18, P = .03. The primary disease of the subjects was mainly cerebrovascular disease (24%) and pneumonia (22%). Abnormal FEES findings including soft palate elevation, velopharyngeal contraction, whiteout, volitional cough, glottis closure during breath holding, cough reflex and presence of secretion in pharynx were found in hospitalised patients with dysphagia. The prevalence of dysphagia was high in hospitalised patients. Hence, screening the swallowing problem by nurse and FEES evaluation is essential to detect and prevent the complication in the patient who has dysphagia.

Endoscopic Findings and Their Association With Gender, Age and Duration of Symptoms in Patients With Dysphagia

“…Dysphagia is a frequent complaint of patients presenting in GI clinics [7][8][9][10]. The causes of dysphagia of esophageal origin that are identified commonly are benign and malignant strictures of esophagus, reflux esophagitis, Schatzki's ring, compression occurring externally from a malignancy, disorders of motility, scleroderma and achalasia [11][12][13][14][15][16]. In some population-based studies, the rates of prevalence of dysphagia have been reported to be 17-25% with a peak in symptoms at the age of 40-49 years for both gender [17,18].…”

Current approaches to reporting pharyngo-laryngeal secretions

“…Despite the availability of valid reporting tools, there is a lack of use of standardized secretion ratings in existing literature. Many recent studies assess secretions as a dichotomous variable, or use their own choice of categorization, which primarily focus on the location/depth of secretion pooling [7,8 ▪ ,9,19 ▪ ,20,22,26,27]. A number of recently published intervention studies have assessed secretion severity as a primary or secondary outcome measure to determine responses to therapeutic interventions [26,28]; however, only one used a validated tool [28].…”

“…The predictive value of accumulated secretions for swallow impairment and health outcomes is well established and continues to receive attention in recent publications [7,8 ▪ ,9,10,20]. Yet, understanding of its underlying mechanisms is limited.…”

“…Secretion management and airway protection is functionally complex and relies on intact sensation, effective execution of motor activities such as swallowing and coughing, and a network of brainstem-mediated protective reflexes. It appears that pooled secretions are seldom due to increased secretion production and are more frequently subsequent to sensorimotor deficits and consequently, dysphagia [9]. The last 2 years have contributed to building evidence associating both sensory and motor impairments with secretion accumulation and aspiration risk.…”

“…Saliva is usually cleared from the oral cavity through regular spontaneous swallows; however, accumulation of secretions may occur when this is ineffective [4]. The finding of excess secretions in the pharynx or larynx during endoscopy provides important clinical information about a patient's swallowing efficacy and airway protection, and is strongly associated with pneumonia, aspiration of oral intake, dehydration, malnutrition and prolonged hospitalisation [4–7,8 ▪ ,9,10]. Importantly, several studies have found that secretion severity is more predictive of pneumonia than aspiration of food and drink [11,12].…”