Ann Rehabil Med.  2019 Apr;43(2):187-194. 10.5535/arm.2019.43.2.187.

Predictive Value of Pharyngeal Width at Rest (JOSCYL Width) for Aspiration in Elderly People

• Lee HY
• Jung IH
• Cha E
• Song J
• Jung KI
• Yoo WK
• Ohn SH

• KMID: 2449001
• DOI: http://doi.org/10.5535/arm.2019.43.2.187

Abstract

OBJECTIVE
To develop a new tool for aspiration risk prediction based on pharyngeal width at rest in older adults with symptoms of aspiration.
METHODS
Lateral cervical spine roentgenograms were obtained from 33 older adult patients who complained of dysphagia and from 33 healthy, age-matched controls. Pharyngeal width at rest was measured at two points. We named the average of these two pharyngeal widths "˜JOSCYL Width', calculated "˜JOSCYL Scale', and compared these parameters between dysphagia and control groups. Correlations of individual JOSCYL Width and JOSCYL Scale, with Penetration Aspiration Scale (PAS) and Dysphagia Outcome and Severity Scale (DOSS) scores were analyzed for the dysphagia group. To determine optimal cutoff points for predicting aspiration, a receiver operating characteristic curve analysis was performed on JOSCYL Width and JOSCYL Scale.
RESULTS
Both JOSCYL Width and JOSCYL Scale of the dysphagia group were larger than those of the control group (p<0.001). The correlation between JOSCYL Width and severity of dysphagia was significant for the dysphagia group (PAS p=0.007; DOSS p=0.012). The correlation between JOSCYL Scale and the severity of dysphagia was also significant for the dysphagia group (PAS p=0.009; DOSS p=0.011). Optimal cutoffs for JOSCYL Width and JOSCYL Scale for predicting aspiration were 20.0 mm and 5.9, respectively.
CONCLUSION
JOSCYL Width and JOSCYL Scale can be new indicators for predicting aspiration in older adults. They are both precise and easy to use.

Keyword

Deglutition disorders; Pharynx; Elderly; Aspiration; Dysphagia

MeSH Terms

Adult
Aged*
Deglutition Disorders
Dioctyl Sulfosuccinic Acid
Humans
Pharynx
ROC Curve
Spine
Dioctyl Sulfosuccinic Acid

Figure

• 

  Fig. 1. Lateral cervical spine roentgenogram and VFSS. A lateral cervical spine roentgenogram was obtained at the beginning of the VFSS performed using three types of diets with different viscosities. VFSS, video fluoroscopic swallow study.

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  Fig. 2. The JOSCYL Width. The JOSCYL Width was calculated as an average of two pharyngeal widths, A and B. Lines A and B are for illustrative purposes only and differ from the screen shown on the fluoroscopy device.

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  Fig. 3. Receiver-operating characteristic curves of the JOSCYL Width (A) and the JOSCYL Scale (B) for detecting aspiration (dotted line). The optimal cutoff values of the JOSCYL Width and the JOSCYL Scale for predicting aspiration were 20.0 mm (area under the curve=0.76; 95% CI, 0.596–0.934; sensitivity=62.5%; specificity=64.0%) and 5.9 (area under the curve=0.76; 95% CI, 0.584–0.926; sensitivity=62.5%; specificity=64.0%), respectively, in the dysphagia group.

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