The Role of Aspiration Amount on Airway Protective Responses in People with Neurogenic Dysphagia

Curtis, James A.; Borders, James C; Dakin, Avery E; Troche, Michelle S.

doi:10.1007/s00455-022-10546-x

Cited by 6 publications

(3 citation statements)

References 64 publications

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“…However, in terms of bolus volume, two studies indicated that aspiration events were more likely to occur with increased volumes of liquid bolus (Everton et al, 2018;Gaziano et al, 2015). These findings contradict previous literature that reported variable cough responses across different trial volumes during aspiration events (Curtis et al, 2022;Miles et al, 2018).…”

Section: Interpretation Based On the Literaturecontrasting

confidence: 99%

“…However, the majority of included studies did not specify disease severity, making it challenging to determine its impact on cough responsiveness. A recent study found no significant association between airway protective responses and disease diagnosis or duration, but the small and heterogeneous sample size prevented definitive conclusions regarding the impact of diagnosis and disease severity on cough response effectiveness (Curtis et al, 2022).…”

Section: Interpretation Based On the Literaturementioning

confidence: 96%

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Cough effectiveness during airway invasion in adults with oropharyngeal dysphagia: A systematic review of literature

Alhussainy,

Bertolini,

Kenny

2024

ACS

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BACKGROUND: Cough and swallowing share common neuroanatomic pathways, leading to an overlap between their mechanisms. Despite the widely recognised role of cough as an airway defence mechanism, empirical evidence supporting its effectiveness for airway clearance is lacking. OBJECTIVE: This review summarises and appraises available evidence regarding the effectiveness of cough in response to airway penetration and/or aspiration during videofluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES) in adults with oropharyngeal dysphagia (OD) of any aetiology. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Literature search was conducted in March 2023 and updated in March 2024 across six databases without publication status, language, or date restrictions. Two independent reviewers performed screening, with disagreements resolved through consensus and majority vote. The principal investigator conducted data extraction and quality appraisal using the Downs and Black checklist. RESULTS: Of 6,049 studies retrieved, 25 met the eligibility criteria. Due to heterogeneous reporting, a summary of participant demographics could not be compiled. Absence of a standardised method for measuring cough effectiveness meant meta-analysis was impossible. Nonetheless, an effective cough response to penetration/aspiration was noted for some participants within 17 studies, ineffective cough responses for some within 17 studies, while one study reported a partially effective cough response for participants. CONCLUSIONS: Robust evidence on cough effectiveness is lacking due to study heterogeneity and inconsistent reporting. Developing a standardised tool to assess cough effectiveness would ensure consistency and comparability across studies, improving clinical reporting of VFSS and FEES outcomes.

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Section: Interpretation Based On the Literaturecontrasting

confidence: 99%

Section: Interpretation Based On the Literaturementioning

confidence: 96%

Cough effectiveness during airway invasion in adults with oropharyngeal dysphagia: A systematic review of literature

Alhussainy,

Bertolini,

Kenny

2024

ACS

View full text Add to dashboard Cite

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“…Specifically, we found that when penetration was present, it typically led to residue ratings of ~3% for the laryngeal vestibule and vocal folds (though residue ratings up to 60% were observed). Similarly, we found that when aspiration was present, the median amount of aspiration when present was 10%, with a total range of 1-90% It is interesting to note that recent research from our group has found that aspiration amount is a significant predictor for explaining the absence vs. presence of a cough or throat clear (silent vs. nonsilent aspiration) in people with neurologic disease (45). Specifically, silent aspiration had a median subglottic residue rating of 9%, whereas non-silent aspiration had a median subglottic residue rating of 22%.…”

Section: Penetration-aspirationsupporting

confidence: 72%

Normative Reference Values for FEES and VASES: A Prospective, Observational Study of Non-Dysphagic, Community-Dwelling Adults

Curtis¹,

Borders²,

Dakin³

et al. 2023

Preprint

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Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES) – a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluations of swallowing (FEES). Method: FEES were completed in non-dysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials which varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows.Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (>0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 mL and the average bite size of a 3.0-gram saltine cracker was 1.33 grams. Seventy-eight percent of the trials in this study protocol (except 90 mL trials) were completed in a single swallow.Discussions: The results from this study provide preliminary reference values for VASES in healthy adults across a range of bolus volumes, consistencies, colorants, and swallowing instructions. These normative data provide useful insight into typical swallowing function during FEES with a standardized rating methodology. An open dataset is provided to aide in the diagnosis of normal and abnormal swallowing function in clinical and research practices (https://osf.io/4anzm/).

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Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults

Curtis

Borders

Dakin

et al. 2023

J Speech Lang Hear Res

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Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)—a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). Method: FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration–Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows. Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g saltine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. Discussion: The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing outcomes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample ( N = 39), with most people below the age of 60 years ( n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. Supplemental Material: https://doi.org/10.23641/asha.23504325

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The Role of Aspiration Amount on Airway Protective Responses in People with Neurogenic Dysphagia

Cited by 6 publications

References 64 publications

Cough effectiveness during airway invasion in adults with oropharyngeal dysphagia: A systematic review of literature

Cough effectiveness during airway invasion in adults with oropharyngeal dysphagia: A systematic review of literature

Normative Reference Values for FEES and VASES: A Prospective, Observational Study of Non-Dysphagic, Community-Dwelling Adults

Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults

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