II. Epidemiology
-
Oropharyngeal Dysphagia may occur in 55% of patients after CVA
- Silent aspiration occurs 40-70% of Oropharyngeal Dysphagia patients
- Risk of Aspiration Pneumonia and other complications
III. Prognosis: Predictors of Aspiration Risk after CVA
- Criteria
- Dysphonia
- Dysarthria
- Abnormal Gag Reflex
- Abnormal volitional cough (weak cough on command)
- Cough within 1 minute of water ingestion (5,10,20 cc)
- Voice changes after Swallowing (5, 10, 20 cc)
- Interpretation
IV. History
- See Dysphagia
V. Exam: Bedside Swallow Assessment
- See Dysphagia
- Performed by trained observer (esp. speech pathology)
- Hospital nurses typically perform an initial bedside water swallow screen after suspected CVA and before patient eats
- Water Swallowing test
- Patient drinks 5-30 ml of water (or repeatedly swallows their own Saliva)
- Examiner observes for coughing, Choking or congested voice on Swallowing
- Oxygen Saturation may be performed at same time
- Observe for 2-3% desaturation after Swallowing
- Various viscosities of food and liquid are trialed
- Patient observed after Swallowing a thin liquid, a thick liquid, a puree and a solid food
- Examiner observes for coughing, Choking or congested voice on Swallowing
- Examiner also observe for piecemeal Swallowing (patient requires multiple swallows for each bolus)
- As with water swallow, Oxygen Saturation may be observed for 2-3% desaturation after Swallowing
VI. Imaging: Video Fluoroscopic Swallowing Study
- First-line imaging study indicated in faile bedside Swallowing assessment
- Accurately measures presence and degree of aspiration with Swallowing
- Modified barium swallow performed in radiology suite by radiologist and speech pathology
VII. Imaging: Fiber-Optic Endoscopic Swallowing Study
- Adjunctive study to Video Fluoroscopic Swallowing Study
- Identifies bolus residue (and aspiration residue) in the pharynx and Larynx
- May be used to observe patient-specific efficacy of preventive maneuvers with various food and liquid consistencies
- Minimally invasive study performed by speech pathology typically in combination with medical provider review
VIII. Evaluation: Screening Tools
- Eating Assessment Tool or EAT-10 (Nestle)
- What About Swallowing?
- See Dysphagia
- Standard Dysphagia history is as effective as EAT-10 questionnaire
- Heijnen (2016) Dysphagia 31(2):214-22 +PMID:26753926 [PubMed]
-
Swallowing Quality of Life Questionnaire (SWAL-QOL)
- Requires purchase of Questionnaire
- Sidney Swallow Questionnaire
IX. Management: Moderate to Severe Dysphagia
- See Oropharynngeal Dysphagia
- See Dysphagia Diet
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Diagnostic Procedure (T060) |
| SnomedCT | 433065005 |
| English | Fluoroscopy of gastrointestinal tract using water soluble contrast swallow and meal (procedure), Fluoroscopy of gastrointestinal tract using water soluble contrast swallow and meal |
| Spanish | fluoroscopia de tracto gastrointestinal con contraste hidrosoluble y comida, fluoroscopia de tracto gastrointestinal con contraste hidrosoluble y comida (procedimiento) |
Ontology: Bedside Swallowing and Oral Function Assessment (C2459609)
| Concepts | Diagnostic Procedure (T060) |
| ICD10 | F00ZHZZ |
| English | Physical Rehabilitation and Diagnostic Audiology @ Rehabilitation @ Speech Assessment @ None @ Bedside Swallowing and Oral Function @ None @ None, Bedside Swallowing and Oral Function Assessment |
