Videoendoscopic Evaluation of Saliva Aspiration in a Municipal Hospital

Abstract

Videoendoscopic examination of swallowing is useful to examine for aspiration of saliva and food at the bedside. The purpose of the present study was to compare saliva aspiration to aspiration of food in patients with dysphagia. The subjects were 120 hospitalized patients (73 males, 47 females; mean age 82.8 ± 8.5 yrs) who underwent videoendoscopy. The presence of saliva aspiration, food (thick liquid of two different viscosities, thin liquid and solid food) aspiration, silent aspiration, and aspiration after swallowing were evaluated in each patient. Saliva aspiration was found in 41 (34.2%) patients. Aspiration of liquids with honey-like and nectar-like thicknesses was found in 28 (23.3%) patients and 48 (40.0%) patients, respectively. The total number of cases of aspiration of saliva and/or food was 104 (86.7%). Of these aspirators, silent aspiration was found in 44 (36.7%) patients, and aspiration after swallowing was found in 52 (43.3%) patients. Thick liquid was aspirated more frequently in patients with saliva aspiration. The proportion of silent aspiration and of aspiration after swallowing was higher in the saliva aspiration group. The results indicate that patients who aspirate saliva are also prone to food aspiration. But, there were patients who aspirated saliva but did not aspirate food. These patients were able to carry out direct therapy using thick liquid or other food adjusted properly. Food aspiration after swallowing may be induced by saliva aspiration.the larynx. Thus, saliva accumulates in the hypopharynx and trickles into the trachea during the swallowing reflex and in the intervals between the swallowing reflexes clinically. For patients with saliva aspiration, exercises without food (indirect therapy) are carried out to improve this pharyngeal function first. However, we sometimes encounter patients who can carry out training using food (direct therapy) even if they aspirate saliva. There have been few reports to date regarding the relationship between saliva aspiration and food aspiration. In this study, videoendoscopic examination of swallowing was used to compare saliva aspiration to aspiration of thick liquid with two types of viscosity (nectar-like and honey-like) and other food in patients with dysphagia hospitalized in municipal hospitals. Materials and Methods SubjectsSubjects included 124 patients who were hospitalized at Iida Hospital in Nagano Prefecture between September 2011 and September 2013 who had dysphagia and underwent videoendoscopic examination of swallowing. Four patients who underwent tracheotomy were excluded, giving a final total of 120 patients (73 males, 47 females; mean age 82.8 ± 8.5 yrs, age range 56-98 yrs). The most common reason for hospitalization was pneumonia, accounting for half of the patients, followed by cerebrovascular disease (Table 1). The most common primary disease underlying dysphagia was cerebrovascular disease (Table 2). The nutritional route was oral ingestion alone in 31 patients, combined oral ingestion and tube feeding in 32 pat...