ABSTRACT
Many screening tests for dysphagia can be given at bedside. However, they cannot accurately screen for silent aspiration (SA). We studied the usefulness of a cough test to screen for SA and combined it with the modified water swallowing test (MWST) to make an accurate screening system. Patients suspected of dysphagia (N = 204) were administered a cough test and underwent videofluorography (VF) or videoendoscopy (VE). Sensitivity of the cough test for detection of SA was 0.87 with specificity of 0.89. Of these 204 patients, 107 were also administered the MWST. Fifty-five were evaluated as normal by the screening system, 49 of whom were evaluated as normal by VF or VE. Sixteen were evaluated as "SA suspected" by the screening system; seven of them were normal, and seven were evaluated as having SA by VF or VE. Nineteen were evaluated as aspirating with cough, 14 of whom had aspiration with cough as shown by VF or VE. Seventeen were evaluated as having SA, 15 of whom had SA shown by VF or VE. The cough test was useful in screening for SA. Moreover, a screening system that included MWST and a cough test could accurately distinguish between the healthy who were safe in swallowing and SA patients who were unsafe.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition , Mass Screening/methods , Respiratory Aspiration/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Deglutition Disorders/physiopathology , Deglutition Disorders/prevention & control , Endoscopy , Female , Humans , Male , Middle Aged , Oximetry , Photofluorography , Pilot Projects , Risk Factors , Sensitivity and Specificity , Young AdultABSTRACT
The role of complete dentures in masticatory function is well established, but their effect on swallowing has been little examined. This study investigated the effect of complete dentures on swallowing in the elderly. Lateral projection videofluorography (VF) was performed for nine healthy edentulous elderly volunteers (mean age 73.9 +/- 2.9 years) while they swallowed 8 ml of liquid and paste barium with and without complete dentures. A total of 35 VF records were analyzed for temporal and spatial measurements of oropharyngeal motion during swallowing. The tongue tip contacted the inside of the lip between the upper and lower alveolar ridges during swallowing without but not with complete dentures. The hyoid moved further upward (P = 0.002) during swallowing without dentures (liquid: 5.85 +/- 3.99 mm, paste: 6.41 +/- 5.25 mm) than with dentures (liquid: 3.70 +/- 4.57 mm, paste: 3.69 +/- 4.07 mm). The larynx moved further forward (P = 0.044) during swallowing without dentures (liquid: 6.39 +/- 2.58 mm, paste: 6.46 +/- 2.87 mm) than with dentures (liquid: 5.34 +/- 2.04 mm, paste: 5.93 +/- 1.50 mm). The timing of the movements of these structures was not affected by the presence of the dentures or bolus consistency. These results showed that the hyoid and larynx moved more in swallowing without than with complete dentures, perhaps because of tongue tip protrusion when not wearing dentures. These findings suggest that complete dentures have a significant effect on swallowing function as well as masticatory function in elderly individuals.
