//fpnotebook.com/
Dysphagia Evaluation
Aka: Dysphagia Evaluation, Swallowing Evaluation for Oropharyngeal Dysphagia, Swallowing Exam, Dysphagia after Cerebrovascular Accident, Swallowing Evaluation after Stroke, Bedside Swallow Assessment, Bedside Swallowing Exam, Video Fluoroscopic Swallowing Study, Fiber-Optic Endoscopic Swallowing Study, Endoscopic Swallowing Evaluation
- See Also
- Oropharynngeal Dysphagia
- Dysphagia
- Dysphagia Diet
- Swallowing (Deglutition)
- Oral Medication Modification in Dysphagia
- 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
- 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
- One or less criteria: Mild or no Dysphagia
- Two or more criteria: Moderate to severe Dysphagia
- History
- See Dysphagia
- 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
- 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
- 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
- Evaluation: Screening Tools
- Eating Assessment Tool or EAT-10 (Nestle)
- https://www.nestlehealthscience.com/health-management/gastro-intestinal/dysphagia/eat-10
- Belafsky (2008) Ann Otol Rhinol Laryngol 117(12):919-24 +PMID:19140539 [PubMed]
- 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
- https://stgeorgeswallowcentre.org/sydney-swallow-questionnaire/
- Dwiveldi (2010) Oral Oncol 46(4):e10-4 +PMID:20219415 [PubMed]
- Management: Moderate to Severe Dysphagia
- See Oropharynngeal Dysphagia
- See Dysphagia Diet
- References
- Daniels (2000) Arch Phys Med Rehabil 81:1031 [PubMed]
- Wilkinson (2021) Am Fam Physician 103(2): 97-106 [PubMed]