Cervical Auscultation Synchronized with Images from Endoscopy Swallow Evaluations

Abstract

Cervical auscultation is the use of a listening device, typically a stethoscope in clinical practice, to assess swallow sounds and by some definitions airway sounds. Judgments are then made on the normality or degree of impairment of the sounds. Listeners interpret the sounds and suggest what might be happening with the swallow or causing impairment. A major criticism of cervical auscultation is that there is no evidence on what causes the sounds or whether the sounds correspond to physiologically important, health-threatening events. We sought to determine in healthy volunteers (1) if a definitive set of swallow sounds could be identified, (2) the order in which swallow sounds and physiologic events occur, and (3) if swallow sounds could be matched to the observed physiologic events. Swallow sounds were computer recorded via a Littmann stethoscope from 19 healthy volunteers (8 males, 11 females, age range = 18–73 years) during simultaneous fiberoptic laryngoscopy and respiration monitoring. Six sound components could be distinguished but none of these occurred in all swallows. There was a wide spread and a large degree of overlap of the timings of swallow sounds and physiologic events. No individual sound component was consistently associated with a physiologic event, which is a clinically significant finding. Comparisons of groups of sounds and events suggest associations between the preclick and the onset of apnea; the preclick and the start of epiglottic excursion; the click and the epiglottis returning to rest; the click and the end of the swallow apnea. There is no evidence of a causal link. The absence of a swallow sound in itself is not a definite sign of pathologic swallowing, but a repeated abnormal pattern may indicate impairment. At present there is no robust evidence that cervical auscultation of swallow sounds should be adopted in routine clinical practice. There are no data to support the inclusion of the technique into clinical guidelines or management protocols. More evaluation using imaging methods such as videofluoroscopy is required before this subjective technique is validated for clinical use by those assessing swallowing outside of a research context.