Release: Embargoed until September 24, 2000Contact: Jennifer Felsher202-371-4517 (9/23-27)703-519-1549[email protected]
NEW DIAGNOSTIC TOOL HELPS IDENTIFY POTENTIAL SWALLOWING DISORDERS IN AT-RISK PATIENTS
Study suggests that assessment of patients' capacity to protect their airway before food is administered will very likely result in a safer swallow
Washington, DC -- Individuals affected by stroke, neurological diseases (such as Parkinson's Disease), coronary artery disease, chronic obstructed pulmonary disease, tracheostomy, or dysphagia, can all experience difficulty with the seemingly innocuous function of swallowing. These patients, who have severe sensory deficits in the hypopharynx, are at increased risk for aspirating liquids or food while swallowing, which can develop into the potentially life-threatening complication of pneumonia.
A team of researchers from Manhasset, NY, have tested a new procedure that will help determine whether or not compromised patients can safely swallow. The authors of this study, "Laryngopharyngeal Sensory Deficits as a Predictor of Aspiration," are Michael Setzen, MD, Manderly A. Cohen, MS, Philip W. Perlman, MD, Kenneth F. Mattucci, MD, and Michael K. Ditkoff, MD. Dr. Setzen will present the group's findings on Tuesday, September 26, 2000, at the Annual Meeting/Oto Expo of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation being held at the Washington, DC Convention Center, September 24-27.
Two tests traditionally used to assess swallowing ability are the Modified Barium Swallow (MBS) and the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Both of these tests are executed concurrent with the administration of food, thereby increasing the chances of aspiration, and do not provide direct evaluation of the sensory component of a swallow. Therefore, the authors state that it would be beneficial for clinicians and patients to have a diagnostic test of swallowing that is done before food is administered and that provides for direct assessment of the sensory component.
This study was conducted using a minimally invasive endoscopic technology, the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), to assess patients' ability to protect their airways (a safe swallow). This diagnostic tool directly assesses airway protection by endoscopically administering discrete pulses of air to the nerves in order to elicit the laryngeal adductor reflex (LAR), which is defined as transient vocal fold closure following stimulation.
For the first time, this study demonstrates that patients who are unable to protect their airways as determined by the FEESST are at risk for laryngeal penetration and aspiration on any given swallow, particularly with thin liquids.
Methodology: Forty patients diagnosed with dysphagia (difficulty in swallowing) were divided into two groups determined by the results of their FEESST test; each group was comprised of 12 males and eight females. The study group (mean age 72.6) was determined to have absent LAR which indicates severe sensory deficits on the diagnostic test; the control group (mean age 59.2) showed an intact LAR, which indicates normal sensory sensitivity.
A comprehensive swallowing exam was performed on each patient. All were given a 5cc bolus of thin liquid followed by a teaspoon of pureed food. Laryngeal penetration, defined as material that enters the laryngeal vestibule but does not go below the level of the vocal cords, was noted, as was aspiration, which is defined as material that goes below the level of the vocal cords into the trachea.
Statistical analysis was performed using the Fischer's exact test for differences in penetration or aspiration and differences in incidence of pharyngeal muscular weakness.
Results: The study group indicated a 100 percent aspiration with thin liquids. With purees, 85 percent penetrated, and 60 percent aspirated. A muscular contraction impairment of 80 percent was also noted. Comparatively, five percent of the normal or control group experienced penetration and aspiration of liquid, with no penetration by the ingestion of purees. The control group demonstrated a muscular contraction impairment of 20 percent.
Conclusions: The absence of LAR, as determined by using the FEESST diagnostic tool, clearly puts patients with dysphagia at a very high risk for swallowing impairments such as laryngeal penetration and aspiration. There also appears to be a strong correlation between motor function deficits and hypopharyngeal sensory deficits.
The use of FEESST allows clinicians to more accurately and easily determine a dysphagiac patient's potential for aspiration and penetration, which can decrease the incidence of pneumonia caused by this deficiency.
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