Dysphagia
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Comparative Study
Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing.
Aspiration is an important variable related to increased morbidity, mortality, and cost of care for acute stroke patients. This prospective systematic replication study compared a clinical swallowing examination consisting of six clinical identifiers of aspiration risk, i.e., dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow, with an instrumental fiberoptic endoscopic evaluation of swallowing (FEES) to determine reliability in identifying aspiration risk following acute stroke. A referred consecutive sample of 49 first-time stroke patients was evaluated within 24 hours poststroke, first with the clinical examination followed immediately by FEES. ⋯ Clinical examination sensitivity = 86%; specificity = 30%; false negative rate = 14%; false positive rate = 70%; positive predictive value = 50%; and negative predictive value = 73%. It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk in patients with aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk. Careful consideration of the limitations of clinical testing leads us to believe that a reliable, timely, and cost-effective instrumental swallow evaluation should be available for the majority of patients following acute stroke.
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Simultaneous videoradiography and solid-state manometry (videomanometry) were performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction in order to disclose any changes in intrabolus pressure during swallowing maneuvers. Five of the patients had severe pharyngeal dysfunction with frequent misdirected swallows. ⋯ Pharyngeal intrabolus pressure was analyzed at the level of the inferior pharyngeal constrictor. Supraglottic swallow, effortful swallow, and chin tuck did not alter peak amplitude or duration of the intrabolus pressure.
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Epiglottic movement patterns of 500 consecutive patients with varying etiologies were recorded during routine videofluoroscopic swallow evaluations. Seven distinct, commonly repeated, abnormal epiglottic patterns were identified. ⋯ A description of each epiglottic movement pattern is given in conjunction with information regarding aspiration and other variables associated with the swallow process. A universal nomenclature is offered regarding these subtle abnormal epiglottic movement patterns to increase a verbal commonality in our descriptions of epiglottic function as it affects aspiration.