Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients.

OBJECTIVE: This study aimed to determine the effect of topical lidocaine on Penetration-Aspiration Scale (PAS) scores and patient comfort and tolerance of flexible endoscopic evaluation of swallowing (FEES) examinations in dysphagic patients. METHODS: Adults with dysphagia referred for swallowing evaluation were recruited to participate in consecutive nonanesthetized and then anesthetized FEES examinations. Under endoscopic visualization, participants consumed 6 swallows consisting of graduated volumes of milk, pudding, and cracker in each condition and recorded their discomfort and tolerance in the 2 conditions. Penetration-Aspiration Scale scores were assigned in blinded fashion for each swallow. RESULTS: Twenty-five adults participated in the study. Although there was no statistically significant effect of anesthesia on PAS scores (P=.065), the odds of a higher PAS score were 33% higher during anesthetized swallows. The anesthetized condition yielded significantly less discomfort and pain during the examination, significantly less pain and discomfort during insertion and removal of the endoscope, and significantly greater overall tolerance than the nonanesthetized condition. CONCLUSION: The use of topical lidocaine during FEES may impair swallowing ability in patients with dysphagia, but this result does not achieve statistical significance. Topical nasal anesthesia significantly reduces subjective pain and discomfort and improves tolerance during FEES.

Flexible endoscopic evaluation of swallowing in healthy young and older adults.

OBJECTIVES: Scant data exist on normal swallowing as assessed endoscopically. A lack of understanding for the range of normal swallowing may lead to inaccurate diagnoses and overly aggressive management of patients with dysphagia. Accordingly, the purpose of this study was to determine the effects of age (i.e., young versus older), gender, bolus volume (i.e., 5 versus 10 mL), and bolus condition (i.e., water versus milk) on Penetration-Aspiration Scale scores, bolus dwell time, pharyngeal closure duration, and residue in healthy adults. METHODS: Twenty-three young adults (mean, 30.0 years of age) and 21 older adults (mean, 75.0 years of age) participated. Measurements were acquired during manoendoscopic swallowing assessments. The participants contributed 8 swallows, affording a study total of 352 swallows for analysis. RESULTS: The older adults demonstrated penetration on 19 swallows and aspiration on 11 swallows out of 168 swallows. There was a significant difference in the proportion of Penetration-Aspiration Scale scores across age and gender groups. Longer bolus dwell times were seen in older adults and with milk boluses, whereas residue severity was less in young adults and with water boluses. CONCLUSIONS: Endoscopic data on normal swallowing physiology were generated. These data may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.

Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing.

PURPOSE: The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures, durations, and onsets (i.e., onset of upper pharyngeal pressures relative to onsets of UES relaxations and onset of lower relative to upper pharyngeal pressures). METHOD: Twenty-three young adults (M=30 years) and 21 older healthy adults (M=75 years) participated. Measurements were acquired with a 2.1-mm catheter during simultaneous manometric and endoscopic swallowing assessment. Participants contributed 18 swallows, affording a study total of 792 swallows for analyses. RESULTS: There was no significant effect of trial on any measurement of pressure, duration, and onset (ps=.63, .39, and .71, respectively). It was found that viscosity, volume, age, and gender affected pressure, duration, and onset measurements (e.g., onset of upper pharyngeal pressures relative to onsets of UES relaxations) but in varying degrees relative to the location in the pharynx or UES and the type of measurement (e.g., pressure, onset). CONCLUSIONS: Manometric measurements vary with respect to age, gender, and bolus variables and interactions of each. Consideration of these variables is paramount in understanding normal and pathological swallowing if manometry is to develop as a quantitative adjunct to videofluoroscopic and endoscopic swallowing tools.

Differentiation of adductor-type spasmodic dysphonia from muscle tension dysphonia by spectral analysis.

OBJECTIVES: To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia (AdSD) from muscle tension dysphonia (MTD). STUDY DESIGN: Prospective blinded study. METHODS: Forty-seven samples of AdSD-connected speech spectrograms from 27 subjects and 17 samples of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified. These spectrograms were reviewed independently and blindly by two speech language pathologists experienced in spectrography. The speech language pathologists designated the spectrogram as consistent with AdSD and MTD, and these designations were compared with actual clinical diagnoses. RESULTS: The ability to differentiate AdSD from MTD with spectral analysis was 94% for rater #1 and 98% for rater #2. No MTD subjects were incorrectly diagnosed as having SD (100% specificity). CONCLUSIONS: This study suggests that experienced speech language pathologists can distinguish AdSD from MTD with a high degree of sensitivity and specificity based on spectral analysis. Spectral analysis is especially useful in cases where perceptual analysis and clinical evaluation alone are insufficient.