Signs Of Oropharyngeal Dysphagia Research Articles

The Volume-Viscosity Swallowing Test – Portuguese Version: Validation and prevalence of safety and efficacy clinical signs in acute stroke patients

PurposeThe early identification of oropharyngeal dysphagia (OD) in patients after an acute stroke using non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality. The Volume-Viscosity Swallow Test (V-VST) is a screening test that makes it possible. The goal of this study is to contribute to the validation of the V-VST European Portuguese (V-VST: EP) version and study the prevalence of safety and efficacy signs in acute stroke patients. MethodThe V-VST: EP, its instructions manual and algorithm, was presented to a panel of experts, to assess its content validity. It was applied to 33 acute stroke patients, with signs of OD, to analyze its psychometric properties. Finally, the prevalence of impaired signs of safety and efficacy was analyzed. ResultsThe V-VST: EP and its instruction manual (content) demonstrate very good agreement values. Most of the results for inter and intra-evaluator reliability presented Cohen's kappa values higher than 0.60 or 0.80 (75.0%). The concurrent validity (against the 3 OZ wst) presented a sensitivity of 100% and a specificity of 57.1%. For evaluator 1, the results presented are for the nectar, liquid and pudding consistencies, the prevalence values for the 5 ml, 10 ml and 20 ml volume capacity was: impaired lip closure (36%, 39%, 18%), piecemeal deglutition (50%, 50%, 50%), oral residue (7%, 0%, 9%), pharyngeal residue (25%, 17%, 9%) and safe swallowing (89%, 33%, 94%), respectively.

Upper dysphagia in patients affected by systemic sclerosis: prevalence and features.

SUMMARYHerein, we describe the prevalence and features of dysphagia in patients affected by systemic sclerosis (SS). We analysed the data of 19 patients obtained by administering the M.D. Anderson Dysphagia Inventory (MDADI) scale that measures dysphagia symptoms and by physical assessment consisting of judging specific lip, mandible and tongue performances (scale 0-3) and diadochokinesis, respiratory and phonatory functions (scale “poor”, “fair”, “good”, “normal”) according to Robertson’s method. Subjects also underwent flexible endoscopic examination of swallowing. MDADI showed that 74% of answers were included in “mild” class of disability, 21% as “moderate” and 5% as “severe”. The performance of lips, mandible and tongue that most frequently scored 1 were the opening (52.6% for the lips and 47.4% for the mandible) and the pop of the tongue (52.7%). The percentage of compromised respiratory, phonatory and diadochokinesis tests (“poor” or “fair”) was 81%, 70.1% and 74%, respectively. Flexible endoscopic examination of swallowing revealed pharyngolaryngeal sensory deficit and signs of oropharyngeal dysphagia in more than half of cases (58% and 53%, respectively). This study highlights the presence of dysphagia in SS patients and demonstrates the importance of a multidimensional approach that includes subjective and objective evaluation to characterise specific features of swallowing alterations that have a high-impact on upper dysphagia.

Validation of the Dutch EAT-10 for screening of oropharyngeal dysphagia in the elderly population

The prevalence of oropharyngeal dysphagia (OD) in the elderly population >76y is estimated at 26%. OD can lead to malnutrition, depression, diminished quality of life and increased mortality in the elderly. Despite these important complications, OD is still underdiagnosed due to a lack of a reliable and easily applicable screening tool. The Eating Assessment Tool-10 (EAT-10) questionnaire consists of ten statements about symptoms and signs of OD. In the current literature, a cut-off value of ≥3 points is preferred to be considered as in risk for OD. The EAT-10 questionnaire shows good internal consistency and reliability and is validated in different languages with comparable results. The purpose of this study is to validate the EAT-10 questionnaire in Dutch. The results show a strong test-retest reliability (Spearman's rho 0.841) and an internal consistency of 0.917 via Cronbach's alpha. The Dutch EAT-10 questionnaire is well applicable in a clinical environment with a mean duration of 2 minutes and 28 seconds (± 1 minute and 32 seconds) to complete the test. Validation of the Dutch EAT-10 questionnaire makes screening of OD in the Dutch (elderly) population possible.

Fatores associados a sinais sugestivos de disfagia orofaríngea em idosas institucionalizadas

To identify the factors associated to suggestive signs of oropharyngeal dysphagia (OD) in institutionalized elderly women. A cross-sectional, study with 30 institutionalized elderly women (mean age: 83,73±10,56 years) was carried out in Maceió. From August 2007 to July 2008, social, demographic and cultural data was collected, as well as data on general health and deglutition from their medical records and follow-up (both in person and by video) of one meal of each elderly woman. Those with signs suggestive of OD were compared to those with no signs of it and the factors associated with signs suggestive of orophayngeal dysphagia and changes in the feeding dynamics were considered. Regarding the factors associated to changes in feeding dynamics, the elderly with dementia were more likely to require assistance during mealtime and to present four or more changes in feeding dynamics. The elderly that required assistance were more likely to eat in bed, at an inadequate position and to have three or more changes in feeding dynamics. For institutionalized elderly women, the factors associated to signs suggestive of oropharyngeal dysphagia were use of medication, absence of depression, number of teeth and number of changes in feeding dynamics. The factors associated to changes in feeding dynamics are related to dementia and need of special care.

OP018 ASSOCIATION BETWEEN OROPHARYNGEAL DYSPHAGIA AND MALNUTRITION IN ELDERLY PATIENTS WITH ACUTE DISEASES ADMITTED TO A GENERAL HOSPITAL

Rationale: To determine the relationship between oropharyngeal dysphagia (OD), nutritional status and clinical outcome in elderly patients with acute diseases admitted to a general hospital. Methods: Prospective observational study of 1662 patients over 70 years of age consecutively hospitalized in an acute geriatric unit (AGU) in a general hospital. Dysphagia was clinically assessed with the volumeviscosity swallow test (V-VST) and nutritional status with the Mini Nutritional Assessment. Other measurements taken during admission were anthropometry and laboratory values, comorbidities (Charlson index), cognitive status (Pfeiffer) and functional capacity (Barthel index). Mortality during admission, referral to nursing homes and mortality at 12 months after discharge were also monitored. Results: Up to 52.6% patients admitted to the AGU presented clinical signs of OD and a) more comorbidities (2.42+1.6 vs 2.02+1.6 p < 0.001), poorer functionality both pre-admission and at discharge (p < 0.001), more geriatric syndromes (93.3% vs 72.5% p < 0.001) and poorer outcome (1 year mortality 48.7 vs 25.1%) (p < 0.001) and b) higher prevalence of malnutrition (MNA< 17 45.3% vs 18%, p < 0.001; BMI 25.5 vs 26.8, p < 0.001) and albumin <3 g/dl (62.9% vs 37.1%, p < 0.001). Regardless of their functional status and comorbidities, elderly patients with OD were at increased risk of malnutrition (OR 2.31 (1.70 3.14)), referral to nursing homes (OR 1.57 (1.12 2.19)) and increased mortality one year after discharge (OR 1.91 (1.48 2.46)). Conclusion: Oropharyngeal dysphagia is a very prevalent disease among elderly patients with acute diseases admitted to a general hospital, and is closely related to high prevalence of malnutrition and poor outcome.

P305 Overnight oximetry during air travel in subjects with sleep-disordered breathing and healthy controls

Objective: The pharynx is a share conduit for swallowing and respiration. It has been demonstrated that OSAS patients have a decrease of oropharyngeal sensitivity induced by neurogenic lesions, which could therefore affect swallowing function. The aim of the present study was to search if OSAS is associated with oropharyngeal dysphagia symptoms. Material and methods: Ninety-nine consecutive patients suspected to present respiratory sleep disorders without other cause of oropharyngeal dysphagia were prospectively included in the study (55 ± 11 yr; 34 f). Respiratory sleep disorders were diagnosedwith an ambulatory device (CID 102, Cidelec, Sainte Gemmes sur Loire, France). Patients were then classified as normal (AHI 30 n/h). Oropharyngeal dysphagia was assessed using a French questionnaire built as the Voice Handicap Index consisting in 30 statements on oropharyngeal dysphagia on a 0–4 scale (0 never, 4 always) with three subdomains (physical, emotional and functional). Results: Thirty-seven patients were classified as normal, 28 presented amoderateOSASand34hada severeOSAS. Oropharyngeal dysphagia scores showed that OSAS patients had substantial oropharyngeal dysphagia physical symptoms (score = 4 ± 0.5 (M ± SD); range: 0–19) with poor emotional or functional repercussion. Patients with severe OSAS presented a higher physical score than normal patients (respectively, 5 ± 1 vs. 3 ± 0.5; p = 0.05). There was a positive correlation between oropharyngeal physical score and AHI (R = 0.20; p < 0.05) and hypopnea index (R = 0.27; p < 0.01). Conclusion: OSAS patients presented clinical signs of oropharyngeal dysphagia, which could be induced by neurogenic pharyngeal lesions or alterations of pharyngeal muscle control.