The Effects of Posture and Bolus Viscosity on Swallowing in patients with Dysphagia

Chung, Sun Gun; Lee, Seong Jai; Hyun, Jung Keun; Park, Seok Gun

Abstract

The oropharyngeal swallow of 26 patients with dysphagia was studied quantitatively and qualitatively using videofluoroscope. Videofluoroscopic examination was done with head in neutral position, and with three different c onsistency of test meals; thin liquid, thick liquid, and solid, When aspiration or laryngeal penetration was noted in neutral position, the study was repeated with different head positions, We compared them with each other and with 25 normal subject(previously presented). 11/26(42%) patients revealed laryngeal penetration or aspiration at least with one consistency of test meal. Aspiration occurred more frequently in thin liquid than thick liquid or solid, Head position change successfully eliminated aspiration in 10/10 patients(100%). Other one patient could not change his head position. 9 numerical parameters were derived and calculated for quantitative examination, Liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were significantly increased in patients with aspiration than in patients without aspiration. Also significantly increased than those of normal controls. Because different test meal consistency gave different values, direct comparison of values regardless of meal consistency was fruitless. And because all the process of swallowing cannot be expressed as numerical parameters qualitative examination of videofluoroscopic result was essential. In conclusion, liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were useful parameters in differentiating and quantifying dysphagia. Aspiration can be reduced when appropriate position assumed. Calculated values were different a according to the consistency of the test meal. Quantitative analysis was helpful, but qualitative examination of videofluoroscopy was essential.