8-point Penetration-aspiration Scale Research Articles

Critical swallowing functions contributing to dysphagia in patients with recurrent laryngeal nerve paralysis after esophagectomy.

Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy can cause aspiration because of incomplete glottis closure, leading to pneumonia. However, patients with RLNP often have preserved swallowing function. This study investigated factors that determine swallowing function in patients with RLNP. Patients with esophageal cancer who underwent esophagectomy and cervical esophagogastric anastomosis were enrolled between 2017 and 2020. Videofluoroscopic examination of swallowing study (VFSS) and acoustic voice analysis were performed on patients with suspected dysphagia including RLNP. Dysphagia in VFSS was defined as score ≥ 3 of the 8-point penetration-aspiration scale VFSS and acoustic analysis results related to dysphagia were compared between patients with and without RLNP. Among 312 patients who underwent esophagectomy, 74 developed RLNP. The incidence of late-onset pneumonia was significantly higher in the RLNP group than in the non-RLNP (18.9 vs. 8.0%, P = .008). Detailed swallowing function was assessed by VFSS in 84 patients, and patients with RLNP and dysphagia showed significantly shorter maximum diagonal hyoid bone elevation (10.62 vs. 16.75mm; P = .003), which was a specific finding not seen in patients without RLNP. For acoustic voice analysis, the degree of hoarseness was not closely related to dysphagia. The length of oral intake rehabilitation for patients with and without RLNP was comparable if they did not present with dysphagia (8.5 vs. 9.0days). Impaired hyoid bone elevation is a specific dysphagia factor in patients with RLNP, suggesting compensatory epiglottis inversion by hyoid bone elevation is important for incomplete glottis closure caused by RLNP.

IMPACT OF HIGH-FLOW NASAL CANNULA THERAPY ON SWALLOWING: A PROSPECTIVE COHORT STUDY

IMPACT OF HIGH-FLOW NASAL CANNULA THERAPY ON SWALLOWING: A PROSPECTIVE COHORT STUDY

Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients

BackgroundFiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients.MethodsFifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed.ResultsThe patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2–4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706–0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749–0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605–0.906).ConclusionsThe standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.

Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study.

Objective To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia.MethodsA total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively.ResultsThe pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis.ConclusionThe present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.

Evaluation of Swallow Function on Healthy Adults While Using High-Flow Nasal Cannula

Purpose High-flow nasal cannula (HFNC) therapy is used increasingly in critically ill populations under respiratory distress. The interface between respiration and swallowing begs a better understanding of the effects of HFNC on swallow function. The current prospective cohort study investigated the effect of HFNC on swallow physiology in healthy adults. Method Eighty adults aged 35–65 years underwent modified barium swallow studies under varying flow rates of HFNC (0, 20, 40, and 60 liters per minute [lpm]). Modified barium swallow studies were scored by a blinded speech-language pathologist for 17 components of swallow function as defined by the Modified Barium Swallow Impairment Profile (MBSImP) and severity of penetration and aspiration as defined by the 8-point Penetration-Aspiration Scale ( Rosenbek, Robbins, Roecker, Coyle, &amp; Wood, 1996 ). Results Total MBSImP scores were statistically significantly higher at the highest flow rate (60 lpm) than those at any other flow rate. MBSImP components 1 (lip closure), 2 (tongue control during oral bolus hold), and 5 (oral residue) demonstrated statistical relevance to various flow rates. MBSImP components 12 (pharyngeal stripping wave) and 15 (tongue base retraction) were significant to age group. The 8-Point Penetration-Aspiration Scale scores were not significantly associated with flow rate nor age group. Conclusion The current study demonstrated that oral swallowing changes occur in healthy adults wearing HFNC at a high-flow rate (60 lpm). We postulate that healthy adults are able to compensate for swallowing changes while wearing HFNC; we suggest that cognition is a critical factor when evaluating patient populations for safe initiation of oral alimentation.

Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy.

Background: Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia.Methods: We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment.Results: FOIS (p = 0.003 in hemispheric group and p = 0.039 in brainstem group) and FDS (p = 0.006 in hemispheric group and p = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI.Conclusion: Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.

Dysphagia after brain stem infarction: A quantitative analysis of videofluoroscopic observations

Objective To evaluate the characteristics of dysphagia after brain stem infarction, and to determine the mechanism of aspiration. Methods The fluoroscopic videos of 12 dysphagia patients who had suffered brain stem infarction and 10 healthy counterparts were analyzed quantitatively using a digital analysis system. Each participant was requested to twice swallow 5ml of thick liquid. The observations included the oral transit time (OTT), the swallow response time (SRT), the hyoid movement time (HMT), the upper esophageal sphincter opening time (UOT) and the laryngeal closure time (LCT). An 8-point penetration-aspiration scale (PAS) was used to evaluate the severity of aspiration, and the results were correlated with the other 5 quantitative observations. Results The average OTT [(3.091±1.803)s], HMT [(1.498±0.550)s] and LCT [(0.651±0.186)s] of the brain stem infarction patients were all significantly longer than those of the healthy controls. However, no significant differences were found between the patients and the healthy volunteers in terms of SRT or UOT. Aspiration severity was significantly correlated with SRT but not with LCT. Conclusion Dysphagia after brain stem infarction involves both the oral and pharyngeal phases. OTT, HMT and LCT can be used to quantify dysphagia after brain stem infarction, while SRT is a predictor of aspiration. Key words: Brain stem infarction; Dysphagia; Videofluoroscopy

Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study

Background & aimsStroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS. MethodWe conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration–Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures–Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters. ResultsTMSreal exhibited significant improvement in all swallowing outcomes—neurophysiological, radiological, and functional—compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05). ConclusionsOur results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation. Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02893033.

A Significant Association of Malnutrition with Dysphagia in Acute Patients.

Dysphagia and malnutrition seem to be associated, but little research in detail has been reported. We aimed to clarify the association between dysphagia and malnutrition by adopting accurate diagnosis and mathematical evaluation of dysphagia using videofluorography and nutritional assessment calculated by a well-established nutritional risk index. We conducted a retrospective analysis of 165 enrolled patients who were admitted to our hospital for acute diseases and underwent videofluorography on suspicion of dysphagia in the year 2016. We diagnosed high-risk dysphagia in patients with 8-point penetration-aspiration scale (PAS) score over 4. We used the geriatric nutritional risk index (GNRI) as a nutritional assessment tool. A GNRI score less than 91.2 corresponds to malnutrition. The median age of 165 enrolled patients was 76.0, and the number of female patients was 53. The mean GNRI was 81.2, and 134 patients (81.2%) had malnutrition. The number of the patients with a diagnosis of high-risk dysphagia was 54 (32.7%). The GNRI of patients with high-risk dysphagia was significantly less than that of patients without (mean value 77.7±10.5 vs. 83.0±10.5, P=0.003). GNRI<91.2 was independently and significantly associated with high-risk dysphagia (OR 3.094; CI 1.057-9.058; P=0.039). Based on the current study, the authors propose evaluating nutritional status to predict dysphagia risk of patients in the acute phase.

Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study.

Dysphagia might affect 12% of the general population, and its complications include pneumonia, malnutrition, social isolation, and death. No validated Spanish symptom survey exists to quantify dysphagia symptoms among Latin Americans. Therefore, we performed a prospective cohort study in a tertiary care university hospital to validate the Spanish version of the 10-Item Eating-Assessment-Tool (EAT-10spa) for use in Colombia. After an interdisciplinary committee of five bilingual specialists evaluated the EAT-10spa(translated and validated in Spain) and deemed it appropriate for the Colombian culture, its feasibility, reliability, validity, sensitivity to change, and diagnostic capacity were evaluated. As a reference standard, we used the flexibleendoscopic evaluation of swallowing with sensory testing and a standardized clinical evaluation. All assessments were blinded. In total, 133 subjects were included (52% women, mean age 55years) and completed the EAT-10spa (median completion time: 2min [IQR 1-3min]), 39% of whom had an elementary-level education. Cronbach's α coefficient: 0.91; test-retest intra-class correlation coefficient: 0.94. The Spearman's correlation coefficient of the EAT-10spa with the 8-point penetration-aspiration scale was 0.54 (P<0.001). The area under the receiver-operating-characteristic-curve (AUC-ROC) for dysphagia and aspiration were 0.79 (P<0.001)and 0.81 (P<0.001), respectively. The best cut-off points for dysphagia and aspiration were EAT-10spa ≥2 (sensitivity 93.6%, specificity 36.4%) and EAT-10spa ≥4 (sensitivity 94.3%, specificity 49.5%), respectively. A reduction in the EAT-10 ≥3 was the best cut-off point for a clinically significant improvement (AUC-ROC 0.83; P<0.0001). The EAT-10spa showed excellent psychometric properties and discriminatory capacity for use in Colombia.

The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study

ObjectiveTo examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. DesignIntervention study; before-after trial with 4-week follow-up through an online survey. SettingOutpatient university clinics. ParticipantsA consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. InterventionsParticipants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45min/d. Main Outcome MeasuresOutcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). ResultsThe Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η2=.8146 and P<.05, η2=.799708, respectively) and level of oral intake (P<.005, Cohen d=−1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38–14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported. ConclusionsThe Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.

Analysis of Dysphagia Patterns Using a Modified Barium Swallowing Test Following Treatment of Head and Neck Cancer.

PurposeThe purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer.Materials and MethodsA retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score.ResultsReduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%).ConclusionReduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.

Functional Outcome in Acute Stroke Patients with Oropharyngeal Dysphagia after Swallowing Therapy

Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration-aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P < .05). When comparing the results of the VFS among the 3 groups, we found significant improvements in patients eating cookies and thick liquid after combined NMES/TS therapy (P < .05). In acute stroke patients with dysphagia, combined NMES/TS therapy is the most effective swallowing therapy in taking solid diets and thick liquids.

The Effects of Lingual Intervention in a Patient With Inclusion Body Myositis and Sjögren's Syndrome: A Longitudinal Case Study

Malandraki GA, Kaufman A, Hind J, Ennis S, Gangnon R, Waclawik A, Robbins J. The effects of lingual intervention in a patient with inclusion body myositis and Sjögren's syndrome: a longitudinal case study. ObjectiveTo report the 5-year course of a patient's swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program. DesignThis is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods. SettingThe study was completed in 2 settings—an outpatient swallowing clinic at an acute care hospital and the patient's home. ParticipantThe subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögren's syndrome. InterventionThe patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5). Main Outcome MeasuresThree outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale. ResultsIsometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment. ConclusionsWe conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögren's syndrome.

The Influence of Laterality of Pharyngeal Bolus Passage on Dysphagia in Hemiplegic Stroke Patients

ObjectiveTo investigate swallowing laterality in hemiplegic patients with stroke and recovery of dysphagia according to the laterality.MethodThe sample was comprised of 46 dysphagic patients with hemiplegia after their first stroke. The sample's videofluoroscopic swallowing study (VFSS) was reviewed. Swallowing laterality was determined by the anterior-posterior view of VFSS. We measured width difference of barium sulfate liquid flow in the pharyngoesophageal segment. If there was double or more the width of that from the opposite width in the pharyngoesophageal segment more than twice on three trials of swallowing, then it was judged as having laterality. Subjects were assigned to no laterality (NL), laterality that is ipsilateral to hemiplegic side (LI), and laterality that is contralateral to hemiplegic side (LC) groups. We measured the following: prevalence of aspiration, the 8-point penetration-aspiration scale, and the functional dysphagia scale of the subjects at baseline and follow up.ResultsLaterality was observed in 45.7% of all patients. Among them, 52.4% were in the hemiplegic direction. There was no significant difference between groups at baseline in all measurements. When we compared the changes in all measurements on follow-up study, there were no significant differences between groups.ConclusionThrough this study, we found that there was no significant relation between swallowing laterality and the severity or prognosis of swallowing difficulty. More studies for swallowing laterality on stroke patients will be needed.

Teledynamic Evaluation of Oropharyngeal Swallowing

The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing. In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patients participated in 2 separate fluoroscopic swallowing evaluations--one traditional on site and one telefluoroscopic off site--through the use of a telemedicine system. Agreement between sites was tested for 3 categories of variables: (a) overall severity of swallowing difficulty, (b) presence and extent of laryngeal penetration and aspiration as rated by the 8-point Penetration-Aspiration scale, and (c) treatment recommendations. Results showed overall good agreement in subjective severity ratings (κ = 0.636) and in Penetration-Aspiration scale ratings (mean absolute difference = 1.1 points) between the onsite and offsite clinicians. Agreement in treatment recommendations was moderate to high, ranging from 69.3% to 100%. The present study supports the feasibility and clinical utility of a telemedicine system for evaluating oropharyngeal swallowing. Given the difficulty and expertise needed to complete such evaluations, this study offers promising clinical avenues for patients in rural, remote, and underserved communities and countries where expert swallowing specialists are not available.

Defining Swallowing Function by Age

Although it is well known now that age affects swallowing function, few data have been reported for larger bolus sizes, such as 20 mL or sequential cup swallows, and few have reported data on the “oldest old,” or those older than 80 years. The purpose of this investigation was to provide data for future investigations on adults, ranging in age from 21 to older than 100 years, using thin liquid, puree, and solid boluses, ranging from 5 mL to 3 oz, and to add to the database regarding the effects of age, gender, bolus size, and bolus volume on swallowing function. Symptoms relating to swallowing dysfunction were also examined, including the presence of oropharyngeal residue and penetration-aspiration. Having incorporated data on larger swallows from older individuals than in the past and incorporating an 8-point penetration-aspiration scale, several findings emerged in this investigation that have not been clearly defined in prior research as being results of the aging process. Most prominently, it was observed that for older individuals laryngeal penetration is common, often with material remaining in the laryngeal vestibule after the swallow. Differences in oral transit duration and the duration of the onset of the pharyngeal swallow that may result from varying methodologies are also discussed. Implications are drawn for the appropriate evaluation and management of older adults with suspected dysphagia.

Effects of Cuff Deflation and One-Way Tracheostomy Speaking Valve Placement on Swallow Physiology

This study examined the effects of tracheostomy cuff deflation and one-way speaking valve placement on swallow physiology. Fourteen nonventilator-dependent patients completed videofluoroscopic swallow studies (VFSS) under three conditions: (1) cuff inflated, (2) cuff deflated, and (3) one-way valve in place. Four additional patients with cuffless tracheostomy tubes completed VFSS with and without the one-way valve in place. All swallows were analyzed for the severity of penetration/aspiration using an 8-point penetration-aspiration scale. Seven preselected swallow duration measures, extent of hyolaryngeal elevation and anterior excursion, and oropharyngeal residue were also determined. Scores on the penetration-aspiration scale were not significantly affected by cuff status, i.e., inflation or deflation. However, one-way valve placement significantly reduced scores on the penetration-aspiration scale for the liquid bolus. Patients who are unable to tolerate thin liquids may be able to safely take thin liquids when the valve is in place. However, one-way valve placement may not be beneficial for all patients. Clinicians who complete VFSS with tracheostomized patients should include several bolus presentations with a one-way speaking valve in place before making any decisions regarding the use of the valve as a means to reduce aspiration.