Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES

Abstract

This study investigated the reliability and validity (sensitivity and specificity) of cervical auscultation (CA) using both swallow and pre-post swallow-respiratory sounds, as compared with Flexible Endoscopic Evaluation of Swallowing (FEES). With 103 swallow-respiratory sequences from 23 heterogenic patients, these swallows sounds were rated by eight CA-trained Speech-Language Pathologists (SLPs) to investigate: (1) if the swallow was safe (primary outcome); (2) patient dysphagia status; (3) the influence of liquid viscosity on CA accuracy (secondary outcomes). Primary outcome data showed high CA sensitivity (85.4%), and specificity (80.3%) with all consistencies for the safe measurement, with CA predictive values of > 90% to accurately detect unsafe swallows. Intra-rater reliability was good (Kappa = 0.65), inter rater reliability moderate (Kappa = 0.58). Secondary outcome measures showed high sensitivity (80.1%) to identify if a patient was dysphagic, low specificity (22.9%), and moderate correlation (rs= 0.62) with FEES. A difference across bolus viscosities identified that CA sensitivities (90.1%) and specificities (> 84.7%) for thin liquids were greater than for thick liquids (71.0–77.4% sensitivities, 74.0–81.3% specificities). Results demonstrate high validity and moderate-good reliability of CA-trained SLPs to determine swallow safety when compared with FEES. Data support the use of CA as an adjunct to the clinical swallow examination. CA should include pre-post respiratory sounds and requires specific training. Clinical implications: The authors advocate for holistic dysphagia management including instrumental assessment and ongoing CSE/review + CA. Adding CA to the CSE/review does not replace instrumental assessment, nor should CA be used as a stand-alone tool.