Skip to main content
SpringerLink
Log in

Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Reduced laryngeal sensation and accumulated pharyngeal secretions are known predictors of aspiration. Yet, their association with residue has not been fully explored. One Hundred and ten fiberoptic endoscopic examination of swallowing (FEES) examinations were retrospectively analyzed. Murray’s secretion scale (MSS) for secretion stasis and laryngeal sensation were tested for association with residue severity (Yale pharyngeal residue severity rating scale, YPR-SRS) and the number of swallows required to clear the bolus. The bolus challenges of each consistency (liquid, purée and solid) with the highest PAS and YPR-SRS scores were analyzed. Impaired laryngeal sensation (ILS) and MSS were both independently significantly associated with higher YPR-SRS for all consistencies examined. Mean YPR-SRS for patients with both ILS and secretion stasis was respectively 2.4 ± 1.1, 2.5 ± 1.2, 2.4 ± 1.2 for liquid, purée and solids in the vallecula, and 2.9 ± 1.3, 2.3 ± 1.1, 2 ± 1 for pyriform sinuses residue compared to 1.8 ± 0.7, 1.6 ± 1, 1.6 ± 1 for vallecular residue and 1.8 ± 0.8, 1.4 ± 0.8, 1.3 ± 0.7 for pyriform sinus residue of patients with normal laryngeal sensation and no stasis (p < 0.05 for all except liquids in vallecula). The combined findings of both ILS and MSS ≥ 1 had a sensitivity of 25.9%, specificity of 94.2%, positive predictive value (PPV) of 83.3% and negative predictive value (NPV) of 53.3% for prediction of pharyngeal residue and a sensitivity of 58.3%, specificity of 88.8%, PPV of 39.9% and a NPV of 94.6% for prediction of aspiration. Both ILS and MSS were significantly associated with increased number of swallows required to clear a bolus. Abnormal laryngeal sensation and secretion stasis are associated with pharyngeal residue severity and reduced residue clearing on FEES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia. 2015;30(2):114–20.

    Article  PubMed  Google Scholar 

  2. Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med. 2007;20:144–50.

    Article  PubMed  Google Scholar 

  3. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.

    Article  PubMed  Google Scholar 

  4. Serra-Prat M, Hinojosa G, Lopez D, Juan M, Fabre E, Voss DS, Calvo M, Marta V, et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc. 2011;59:186–7.

    Article  PubMed  Google Scholar 

  5. Cabré M, Serra-Prat M, Force LL, Almirall J, Palomera E, Clave P. Oro- pharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly: observational prospective study. J Gerontol A Biol Sci Med Sci. 2013;69(3):330–7.

    Article  PubMed  Google Scholar 

  6. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10:380–6.

    Article  CAS  PubMed  Google Scholar 

  7. Coates C, Bakheit AM. Dysphagia in Parkinson’s disease. Eur Neurol. 1997;38:49–52.

    Article  CAS  PubMed  Google Scholar 

  8. Bloem BR, Lagaay AM, vanBeek W, Haan J, Roos RAC, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300:721–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Garcia-Peris P, Paron L, Velasco C, de la Cuerda C, Camblor M, Breton I, Herencia H, Verdaguer J, Navarro C, Clave P. Long- term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr. 2007;26:710–7.

    Article  CAS  PubMed  Google Scholar 

  10. Nguyen NP, Frank C, Moltz CC, et al. Impact of dysphagia on quality of life after treatment of head and neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:772–8.

    Article  PubMed  Google Scholar 

  11. Campbell BH, Spinelli K, Marbella AM, et al. Aspiration, weight loss and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg. 2004;130:1100–3.

    Article  PubMed  Google Scholar 

  12. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17:139–46.

    Article  PubMed  Google Scholar 

  13. Eisenhuber E, Schima W, Schober E, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol. 2002;178(2):393–8.

    Article  Google Scholar 

  14. Shapira-Galitz Y, Shoffel-Havakuk H, Lahav Y, Halperin D. Correlation between pharyngeal residue severity and aspiration in patients with dysphagia undergoing FEES. Oral presentation at the European Society of Swallowing Disorders 2017 Congress, Barcelona, Spain, September 2017.

  15. Van der Berg M, Rutten H, Rasmussen-Conrad E, et al. Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head Neck. 2013;36(1):60–5.

    Article  PubMed  Google Scholar 

  16. Cabré M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39:39–45.

    Article  PubMed  Google Scholar 

  17. Pisegna JM. Rethinking residue, an investigation of pharyngeal residue on flexible endoscopic evaluation of swallowing: the past, present, and future directions. Boston University OpenBU Theses and Dissertations; 2017.

  18. Link DT, Willging JP, Miller CK, Cotton RT, Rudolph CD. Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol. 2000;109:899–905.

    Article  CAS  PubMed  Google Scholar 

  19. Donzelli J, Brady S, Wesling M, Craney M. Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow. Ann Otol RhinolLaryngol. 2003;112:469–75.

    Article  Google Scholar 

  20. Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11:99–103.

    Article  CAS  PubMed  Google Scholar 

  21. Kuo CW, Allen CT, Huang CC, Lee CJ. Murray secretion scale and fiberoptic endoscopic evaluation of swallowing in predicting aspiration in dysphagic patients. Eur Arch Otorhinolaryngol. 2017;274(6):2513–9.

    Article  PubMed  Google Scholar 

  22. Aviv JE, Spitzer J, Cohen M, Ma G, Belafsky P, Close LG. Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngealpenetration and aspiration. Laryngoscope. 2002;112(2):338–41.

    Article  PubMed  Google Scholar 

  23. Onofri SM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256–61.

    Article  PubMed  Google Scholar 

  24. Sato S, Fujishima I, Setsu K, Katagiri N, Inao R, Mizuma M. Evaluation for dysphagia by testing laryngeal sensation with a flexible laryngoscope. Jpn J Dysphagia Rehabil. 2002;6(4):44–52.

    Google Scholar 

  25. Aviv JE, Kim T, Sacco RL, Kaplan S, Goodhart K, Diamond B, Close LG. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol. 1998;107:378–87.

    Article  CAS  PubMed  Google Scholar 

  26. Kaneoka A, Pisegna JM, Inokuchi H, Ueha R, Goto T, Nito T, Stepp CE, LaValley MP, Haga N, Langmore SE. Relationship between laryngeal sensory deficits, aspiration, and pneumonia in patients with Dysphagia. Dysphagia. 2017. https://doi.org/10.1007/s00455-017-9845-8. [Epub ahead of print].

  27. Miles A, Hunting A, McFarlane M, Caddy D, Scott S. Predictive value of the new zealand secretion scale (NZSS) for Pneumonia. Dysphagia. 2018;33(1):115–22.

    Article  PubMed  Google Scholar 

  28. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–9.

    Article  CAS  PubMed  Google Scholar 

  29. Fife TA, Butler SG, Langmore SE, Lester S, Wright SC Jr, Kemp S, Grace-Martin K, Lintzenich CR. Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients. Ann Otol Rhinol Laryngol. 2015;124(3):206–11.

    Article  PubMed  Google Scholar 

  30. O’Dea MB, Langmore SE, Krisciunas GP, Walsh M, Zanchetti LL, Scheel R, McNally E, Kaneoka AS, Guarino AJ, Butler SG. Effect of lidocaine on swallowing during FEES in patients with Dysphagia. Ann Otol Rhinol Laryngol. 2015;124(7):537–44.

    Article  PubMed  Google Scholar 

  31. Neubauer PD, Rademaker AW, Leder SB. The yale pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia. 2015;30(5):521–8.

    Article  PubMed  Google Scholar 

  32. Farneti D. Pooling score: an endoscopic model for evaluating severity of dysphagia. Acta Otorhinolaryngol Ital. 2008;28:135–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Rosenbek JC, Robbins JA, Roecker EB, Coyle JC, Wood JL. A. penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  34. Kaspar K, Ekberg O. Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care. In: Cichero J, Clave P, editors. Stepping stones to living well with dysphagia, Nestle nutr inst workshop ser, vol 72: 19–31.

  35. Poorjavad M, Jalaie S. Systemic review on highly qualified screening tests for swallowing disorders following stroke: validity and reliability issues. J Res Med Sci. 2014;19(8):776–85.

    PubMed  PubMed Central  Google Scholar 

  36. Poorjavad M, Jalaie S. Systemic review on highly qualified screening tests for swallowing disorders following stroke: validity and reliability issues. J Res Med Sci. 2014;19(8):776–85.

    PubMed  PubMed Central  Google Scholar 

  37. Kaspar K, Ekberg O. Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care. Nestle Nutr Inst Workshop Ser. 2012;72:19–31.

    Article  PubMed  Google Scholar 

  38. Logemann JA. Evaluation and treatment of swallowing disorders. San Diego: College Hill Press; 1983. p. 6.

    Google Scholar 

  39. Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope. 2017;127(7):1615–21.

    Article  CAS  PubMed  Google Scholar 

  40. Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9(2):90–5.

    Article  CAS  PubMed  Google Scholar 

  41. Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28(4):494–500.

    Article  PubMed  Google Scholar 

  42. Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154:965–74.

    Article  CAS  PubMed  Google Scholar 

  43. Kaneoka A, Pisegna JM, Krisciunas GP, Nito T, LaValley MP, Stepp CE, Langmore SE. Variability of the pressure measurements exerted by the tip of laryngoscope during laryngeal sensory testing: a clinical demonstration. Am J Speech Lang Pathol. 2017;26(3):729–36.

    Article  PubMed  Google Scholar 

Download references

Funding

This study has not received funding.

Author information

Authors and Affiliations

  1. The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel

    Yael Shapira-Galitz, Hagit Shoffel-Havakuk, Doron Halperin & Yonatan Lahav

  2. Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Tel-Aviv University, Petah-Tikva, Israel

    Hagit Shoffel-Havakuk

Authors
  1. Yael Shapira-Galitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hagit Shoffel-Havakuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Doron Halperin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yonatan Lahav
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yael Shapira-Galitz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shapira-Galitz, Y., Shoffel-Havakuk, H., Halperin, D. et al. Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing. Dysphagia 34, 548–555 (2019). https://doi.org/10.1007/s00455-019-10001-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-019-10001-4

Keywords

Search

Navigation