Screening test for silent aspiration at the bedside.

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.

Videofluoroscopic kinesiologic analysis of swallowing: defining a standard plane.

PURPOSE: The Videofluorographic Swallowing Study (VFSS) has become the routine method for assessing swallowing dysfunction and accordingly, much research has been conducted on this procedure. However, due to a lack of standardization of the method of analysis of VFSS, it is often difficult to compare the results of such studies. Therefore, we conducted a comparative study of VFSS's spatial measurement using different standard planes used in the past study and Camper's plane and examined which plane was the most preferable. METHOD: VFSS was performed on 20 healthy young volunteers (26.9 +/- 3 years) and 9 healthy elderly (77.3 +/- 3 years). Each subject swallowed 4ml of thin liquid barium. We measured hyoid displacement and opening of the upper esophageal sphincter (UES) by using four different standard planes. RESULTS: In the young group, the correlation between anterior hyoid displacement and UES opening was significant in all standard planes. In the elderly group, the correlation between anterior hyoid displacement and UES opening was significant only in Camper's plane. Moreover, this plane is hard to be affected by morphological change as ageing. CONCLUSIONS: Camper's plane was found to be as the most preferable plane for analyzing swallowing function.