The Safety of Videofluoroscopic Swallowing Study (VFSS)

OBJECTIVE: The risk of barium aspiration has been reported through animal and clinical studies. Although the barium aspiration occurs frequently during videofluoroscopic barium swallowing study (VFSS) that is used in a standard method for diagnosis of dysphagia, there has been no research about the risk of VFSS. METHOD: One hundred VFSS of sixty nine patients were analyzed prospectively. The patients were diagnosed to dysphagia clinically. VFSS findings were classified into 5 groups according to the severity of aspiration. The incidences of complications, such as fever (>38.3oC), leukocytosis (>10,000), dyspnea and abnormality of chest roentgenogram within 24hours after VFSS were determined in each group. Odds ratios of complications after VFSS for severity of their findings were calculated. RESULTS: The complications of VFSS are as follows; five febrile conditions, three leukocytosis and three dyspnea among 100 VFSS cases. Odds ratios for complications were over 1 except for the abnormality of chest roentgenogram, but which was not statistically significant. CONCLUSION: The incidence of complication after VFSS was 5% in dysphagic patients. But the severity of complication was mild and there was no statistical significance between complication and aspiration on VFSS, so VFSS was a relatively safe procedure.

The Functional Dysphagia Scale Using Videofluoroscopic Swallowing Study in Stroke Patients

OBJECTIVE: Early detection and identification of the aspiration in stroke patients are essential for the prevention of respiratory complications. The purpose of this study is to develop a simple, easy-to-use, quantifiable functional dysphagia scale for stroke patients using videofluoroscopic swallowing study findings. METHOD: Oral and pharyngeal videofluoroscopic swallowing study findings of a consecutive series of 103 stroke patients were analysed. Items of the functional dysphagia scale were determined by the polychotomous linear logistic regression analysis between videofluoroscopic findings and aspiration. The sensitivity and specificity of the scale, and correlation between the total score of the scale and aspiration grade were measured. RESULTS: The final scale included the following eleven items; The score of lip closure, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, pharyngeal transit time. The sensitivity and specificity of the scale for detecting supraglottic penetration and subglottic aspiration were 81.0%, 70.7% and 78.1%, 77.9% respectively. The total score of the scale was significantly correlated with the severity of aspiration. (Spermann correlation coefficient r=0.58943, p=0.00001). CONCLUSION: We developed functional dysphagia scale using videofluoroscopic swallowing study in stroke patients, which could be used as a simple, easy-to-use, quantifiable method to evaluate the severity of the dysphagia.

A Case of Diffuse Idiopathic Skeletal Hyperostosis with Dysphagia / 대한이비인후과학회지

Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic, ossifying diathesis characterized by ossification and thickening at the site of attachment of a ligament or tendon to bone. Although DISH generally affects the lumbar spine, any segment of the spine may be involved. When cervical spine is affected, the extensive cervical spine osteophytes may produce dysphagia and laryngeal symptoms such as hoarseness, dysphonia, and dyspnea etc. We report a DISH patient with dysphagia as a presenting complaint. Plain radiographs and modified barium swallow (MBS) study demonstrated narrowing of esophagus due to severe cervical vertebral osteophytes. Anterior cervical decompression relieved dysphagia and restored esophageal function without major complications.