Simple Swallowing Provocation Test Research Articles

Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days

ObjectiveTo investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DesignThe study design was a prospective cohort study. Participants were followed for 60 days from admission. SettingLTC wards. ParticipantsStudy participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. InterventionsNot applicable. Main Outcome MeasuresThe outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. ResultsThe incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. ConclusionsOur findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation.

Patients with chronic obstructive pulmonary disease (COPD) are known to present with dysphagia from an early stage. Dysphagia leads to swallowing-related complications, in turn leading to COPD exacerbation. Dysphagia screening is recommended; however little is known of its utility in detecting a COPD phenotype at risk for exacerbation. The simple swallowing provocation test (SSPT), considered to be a standard screening test, requires specific equipment, physician skill and patient discomfort. The aim of this study was to find an easier and less invasive measure to screen for dysphagia in patients with COPD. We retrospectively reviewed patients with COPD who were screened for dysphagia [Repetitive saliva swallowing test (RSST), water swallowing test (WST), SSPT and a questionnaire] from June to November 2016. The patients were classified into two groups according to the presence of COPD exacerbation in the past 3 years (ie, exacerbation and non-exacerbation group), and the dysphagia screening results were compared between the groups. Of the 80 cases included, 42 had 1 or more exacerbations in the past 3 years (exacerbation group), and 38 had none (non-exacerbation group). Statistically significant differences between the groups were observed in the RSST, and vocal change in the WST (P<0.05). There were no significant differences between the groups in the results of SSPT, COPD stage and other clinical status. Compared to the SSPT, RSST and WST may be more appropriate screening methods in patients with COPD. A prospective study is necessary for further assessment.

Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia.

Many elderly patients with pneumonia have aspiration pneumonia. Therefore they must temporarily abstain from oral intake. However, it is difficult to predict whether or not they will be able to start oral intake. The reason is the standard method to evaluate deglutition about pneumonia patients has not been established. In this study we aimed to develop a simple and convenient method that predicts the prognosis of oral intake as nutrition among elderly patients with acute stage pneumonia. Participants were 77 inpatients fasting due to aspiration risk with acute pneumonia. (86.0±7.7years; range 68-105years; men: n=34, women: n=43) during September 2011 and August 2013. Their consciousness levels were determined by Glasgow coma scale (GCS) and swallowing function and cough reflex were evaluated by repetitive saliva swallowing test (RSST), modified water swallow test, simple swallowing provocation test and cough test. Oral intake status at discharge was considered as the objective variable, and these tests were considered as explanatory variables. Then receiver operating characteristic (ROC) curve and the area under the curve (AUC) for each was done. From the ROC curve analysis, GCS ≥14 had the largest AUC (0.79) with a sensitivity and specificity of 0.71 and 0.80. That was followed by RSST ≥1, AUC (0.77) with a sensitivity and specificity of 0.81 and 0.67. These results suggest that GCS and RSST could be useful screening tests for prognostic prediction of oral intake capability in elderly patients with acute pneumonia.

Application of simple swallowing provocation test with fiberoptic endoscopic evaluation of swallowing in a cross-sectional study.

BackgroundThis study aimed to develop a simultaneously swallowing provocation test for dysphagia patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES), as well as to evaluate its efficacy.MethodsIn this test, 0·4 and 2·0 mL volumes of water were dripped into the pharynx under endoscopic examination of swallowing, and determine the latency time (LT) of the swallowing reflex elicited by water. The subjects were 51 bed-bound patients with dysphagia and could be divided into two groups as 35 tube feeding and 16 oral intake subjects. Among the tube feeding subjects, 20 patients who started dysphagia rehabilitation were followed-up to 3 months.ResultsThe mean LT was 7·43 ± 7·19 seconds with 0·4 mL of test water and 5·05 ± 5·59 sec with 2·0 mL. When 0·4 mL water was dripped, LT was significantly longer in tube feeding (10·49 ± 7·97 seconds) than oral intake subgroup (5·72 ± 5·16 seconds) (p < 0·05). After the dietary intervention according to the result of FEES, 5 patients were improved in eating, and 15 patients were unchanged or even got worse among 3-months follow-up investigation. LT with 0.4 ml of test water of the Improved group was 3·16 ± 2·69 seconds and that of unchanged/worsened group was 22·6 ± 17·5 seconds, resulting in the significant difference (p < 0·05).ConclusionsThe results of this study suggest that our endoscopic swallowing test as swallowing provocation test with FEES is a useful examination for dysphagia rehabilitation.

Evaluation of swallowing in acute ischemic stroke patients using both a simple swallowing provocation test and a water swallowing test

【目的】脳梗塞急性期患者に簡易嚥下誘発試験(SSPT)と水飲み試験(WST)を施行し，嚥下性肺炎発症との関連について検討した．【対象・方法】急性期脳梗塞患者127例に対し，食事開始前の入院翌日までにSSPT，WSTを連続して施行した．【結果】18例(14.2%)が肺炎を発症した．WSTは14例(11.0%)に施行不能であったが，SSPTは全例に施行可能であった．SSPT，WSTいずれかの検査において異常反応，もしくは施行不能であった場合を“嚥下スクリーニング検査異常”とした場合，その他の因子から独立して肺炎発症と有意な関連を認め(p=0.012，オッズ比 9.79，95%信頼区間 1.64–58.43)，感度88.9%，陰性反応的中率97.5%であった．【結論】SSPT，WST両検査を併用したスクリーニング法は脳梗塞急性期の嚥下性肺炎発症リスクの評価に有用である．

Simple Swallowing Provocation Test Has Limited Applicability as a Screening Tool for Detecting Aspiration, Silent Aspiration, or Penetration

A number of tests for evaluating dysphagia without using videofluoroscopic examination of swallowing (VF) or videoendoscopic evaluation of swallowing (VE) have been developed. The simple swallowing provocation test (SSPT) is unique because it is performed while in a supine position and does not require the patient's cooperation. However, whether the SSPT detects aspiration or penetration correctly is unclear because its validity determined by VF or VE has not been evaluated. Therefore, we determined the sensitivity, specificity, and predictive accuracy of SSPT followed by VF in 45 patients. The sensitivities of the first-step and the second-step SSPT for the detection of aspiration, silent aspiration, or penetration were 72-75% and 13-17%, respectively; the specificities of the first-step and the second-step SSPT were 38-44% and 80-89%, respectively; and the predictive accuracies of the first-step and the second-step SSPT were 58-67% and 31-49%, respectively. These data suggest that SSPT has limited applicability as a screening tool for aspiration, silent aspiration, or penetration because of its low sensitivity. This test may be useful for patients who cannot undergo other tests due to cognitive and/or linguistic dysfunction.

Assessment of aspiration risk in acute ischaemic stroke—evaluation of the simple swallowing provocation test

Background:Aspiration is a common complication in acute stroke patients and is strongly associated with a poor outcome. Due to an insufficient sensitivity and specificity of clinical bedside tests, further refinements...

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

CHAPTER 21: Diagnosis, treatment, and prevention of aspiration pneumonia (excluding large‐volume aspiration)

Aspiration pneumonia develops as a result of the microaspiration of oral contents due to swallowing dysfunction. Even healthy adults may develop aspiration while sleeping; however, bacteria are usually eliminated by mucociliary transport by the next morning. However, the amount of aspiration increases due to decreased cough reflex or severely impaired mucociliary transport in elderly people or persons with underlying diseases, which associated with humorally or cellularly immune compromised state, leads to the condition of becoming easily infected with aspiration pneumonia. Particularly, patients with cerebral infarction centring on basal ganglion disorder easily develop aspiration pneumonia. There are approximately 108/mL of resident bacteria in the sputum of healthy individuals, which is known to increase to 1011/mL under unsanitary conditions in the mouth or in the presence of periodontal disease. Most oral bacteria are anaerobic, and aerobic bacteria account for only one-tenth to one-hundredth of anaerobic bacteria. Therefore, it is difficult to detect the etiologic agent of aspiration pneumonia by the usual sputum culture test, and further testing is necessary to consider possible bacterial contamination in the mouth. Transbronchial aspiration or percutaneous lung needle aspiration are superior tests to identify the etiologic agent, and it is of value to perform such tests in severe cases or on patients who failed to respond to empiric treatment. Of bacteria causing aspiration pneumonia, anaerobic bacteria such as Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp. are frequently detected. S. milleri spp. that are included in aerobic bacteria in a broad sense may be involved in the development of aspiration pneumonia; however, Bacteroides fragilis is less likely to cause aspiration pneumonia. The most frequently detected anaerobic bacterium is Staphylococcus aureus, followed by Klebsiella, Enterobacter, Streptococcus pneumoniae, and Pseudomonas aeruginosa. The frequency of isolating fungi, Nocardia spp., Actinomyces spp., and Paragonimus spp. is extremely low. Existence of underlying diseases listed in Table 21.1, and the presence of drugs usually used (antipsychotic drugs, anticholinergic agents, and muscle relaxants, etc.) Clinical findings associated with suspected dysphagia Choking while eating, cough, constant croaking sound in the throat, saliva flowing due to the inability to swallow, taking much time to eat, large amounts of dirty sputum, change in the voice quality, etc. Simple tests: Water drinking test, repeated spectrum swallowing test, and simple swallowing provocation test Thorough tests: Plain X-ray, radiography for swallowing, nasal and pharyngolaryngeal fibrescopy, and scintigraphy Antimicrobial agents effective against anaerobic bacteria should be used. Penicillins with a β-lactamase inhibitor, clindamycin, and carbapenem antimicrobial agents, etc. are recommended. Promotion of awareness of eating and drinking, and maintenance of the posture to prevent aspiration Oral care Improvement in aspiration with ACE inhibitors Gastrostomy or tracheo-oesophageal transection (Strict examination necessary to decide if such a procedure is appropriate for the relevant patient.)

痴呆高齢者に対するえん下障害のスクリーニング方法の検討：簡易えん下誘発試験と反復唾液えん下テストの比較

Several bedside portable swallowing tests have been advocated for screening for dysphagia. However, the clinical usefulness and limitation of these tests have not been examined in elderly patients with dementia. We performed the repetitive saliva swallowing test (RSST) and the simple swallowing provocation test (SSPT) in 37 elderly inpatients (81.8 +/- 1.2 years old). Simultaneously, cognitive and verbal communication ability were assessed by the Hasegawa Dementia Scale revised version (HDSR) and the Mini-Communication Test (MCT). RSST was completed only in 22 patients (59%), whereas SSPT was successfully completed in all cases. Scores of HDSR and MCT were significantly lower in patients who were unable to cooperate with RSST compared to successful examinees (HDSR: 7 +/- 1 vs 15 +/- 3, p < 0.0; MCT: 47 +/- 8 vs 81 +/- 5, p < 0.01). Dysphagia was detected in 14 patients (64%) by RSST and 5 (14%) by SSPT. Patients with dysphagia showed significantly lower cognitive function (p < 0.05) and verbal communication ability (p < 0.05). In conclusion, RSST is more sensitive to detect dysphagia in elderly patients; however, compliance with RSST is strongly influenced by the patient's cognitive function and verbal communication ability. Comprehensive geriatric assessment will help to choose an alternative test for dysphagia such as SSPT which is more specific test for aspiration pneumonia.

Detection of aspiration and swallowing disorder in older stroke patients: Simple swallowing provocation test versus water swallowing test

Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Arch Phys Med Rehabil 2000;81:1517-9. Objective: To assess the sensitivity and specificity of a simple swallowing provocation test (SPT) and a water swallowing test (WST) in detecting aspiration pneumonia in elderly patients with stroke. Design: Retrospective comparative study involving a simple 2-step SPT and WST on all subjects. Participants: Twenty-six stroke patients with aspiration pneumonia (mean age, 72.1 ± 4.1yr) and 26 age-matched stroke patients without aspiration pneumonia (mean age, 69.4 ± 3.9yr). Interventions: The normal response to SPT was determined by inducing swallowing reflex within 3 seconds after water injection into the suprapharynx. In WST, subjects drank quantities of 10 and 30mL of water from a cup within 10 seconds. The subject who drank water without interruption—without evidence of aspiration—was determined as normal. Results: The sensitivity and specificity of first-step SPT for the detection of aspiration pneumonia were 100% and 83.8%, respectively. Those of the second-step SPT were 76.4% and 100%, respectively. The sensitivity and specificity of first-step WST using 10mL of water for the detection of aspiration pneumonia were 71.4% and 70.8%, respectively. Those of the second-step WST using 30mL of water were 72% and 70.3%, respectively. Conclusion: SPT is more useful than WST in differentiating patients predisposed to aspiration. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation