Yonsei Med J.  2019 Dec;60(12):1181-1186. 10.3349/ymj.2019.60.12.1181.

Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy

Affiliations
  • 1Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. yi0314@gmail.com
  • 2Department of Otorhinolaryngology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients.
MATERIALS AND METHODS
We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed.
RESULTS
A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05).
CONCLUSION
Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.

Keyword

Deglutition; deglutition disorders; vocal cord dysfunction; endoscopes; fluoroscopy

MeSH Terms

Deglutition
Deglutition Disorders
Endoscopes
Fees and Charges
Fluoroscopy
Humans
Phonation
Pyriform Sinus
Vocal Cord Dysfunction
Vocal Cords
Weights and Measures

Figure

  • Fig. 1 (A) Residue on the subglottic shelf after a liquid diet. (B) Severe vallecula and moderate pyriform sinus retention according to the Yale Pharyngeal Residue Severity Rating Scale.

  • Fig. 2 Valleculae and pyriform sinus area (A) and post-swallow residue (B) measured using pixel-based circumscribed area ratios.


Reference

1. Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008; 19:769–785. PMID: 18940640.
Article
2. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988; 2:216–219. PMID: 3251697.
Article
3. Kim JY, Koh ES, Kim HR, Chun SM, Lee SU, Jung SH. The diagnostic usefulness of the fiberoptic endoscopic evaluation of swallowing. J Korean Acad Rehabil Med. 2011; 35:14–22.
4. Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin Otolaryngol. 2006; 31:425–432. PMID: 17014453.
Article
5. ECRI Health Technology Assessment Group. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Evid Rep Technol Assess (Summ). 1999; (8):1–6.
6. Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007; 117:1723–1727. PMID: 17906496.
Article
7. Rao N, Brady SL, Chaudhuri G, Donzelli JJ, Wesling MW. Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. J Appl Res. 2003; 3:89–96.
8. Pisegna JM, Langmore SE. Parameters of instrumental swallowing evaluations: describing a diagnostic dilemma. Dysphagia. 2016; 31:462–472. PMID: 26987971.
Article
9. Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997; 107:396–401. PMID: 9121321.
Article
10. Langmore S. Endoscopic evaluation and treatment of swallowing disorders. 2nd ed. New York (NY): Thieme;2011.
11. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996; 11:93–98. PMID: 8721066.
Article
12. Pearson WG Jr, Molfenter SM, Smith ZM, Steele CM. Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia. 2013; 28:167–177. PMID: 23089830.
Article
13. Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residue Severity Rating Scale: an anatomically defined and image-based tool. Dysphagia. 2015; 30:521–528. PMID: 26050238.
Article
14. Neubauer PD, Hersey DP, Leder SB. Pharyngeal Residue Severity Rating Scales based on fiberoptic endoscopic evaluation of swallowing: a systematic review. Dysphagia. 2016; 31:352–359. PMID: 26753927.
Article
15. Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991; 100:678–681. PMID: 1872520.
Article
16. Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior? Curr Opin Otolaryngol Head Neck Surg. 2003; 11:485–489. PMID: 14631184.
Article
17. Hiss SG, Postma GN. Fiberoptic endoscopic evaluation of swallowing. Laryngoscope. 2003; 113:1386–1393. PMID: 12897564.
Article
18. McCullough GH, Rosenbek JC, Robbins JA, Coyle JL, Wood JL. Ordinality and intervality of a penetration-aspiration scale. J Med Speech Lang Pathol. 1998; 6:65–72.
19. Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (Fees(R)) using the penetration-aspiration scale: a replication study. Dysphagia. 2002; 17:308–315. PMID: 12355146.
20. Smith CH, Logemann JA, Colangelo LA, Rademaker AW, Pauloski BR. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia. 1999; 14:1–7. PMID: 9828268.
Article
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