The Usefulness of Supine Position on Swallowing of Liquid Diet in Neurogenic Dysphagia: Comparison with Sitting Position

OBJECTIVE: The purpose of this study is to find the proper feeding posture for the safe liquid meal in the patients with neurogenic dysphagia. METHOD: Fifty patients of neurogenic dysphagia with tracheal aspiration diagnosed with the videofluoroscopic swallowing test (VFST) were evaluated. VFST using 5 cc of barium solution was done for each patient in the sitting and supine position. The results of VFST of supine position were analyzed and compared with those of sitting position for the tracheal aspiration, laryngeal penetration, premature leakage, and laryngeal spillage. RESULTS: The incidence of premature leakage, tracheal aspiration, and laryngeal penetration is significantly decreased in the supine position (56%, 14% and 46%) compared to the sitting position (96%, 100% and 100%) (p<0.001). The incidence of laryngeal penetration referable to the swallowing reflex is significantly decreased in the supine position (0%, 46%, 0%) compared to the sitting position (14%, 96%, 44%) (p<0.001). The incidence of nasal regurgitation is 2% in the sitting position and 30% in the supine position. CONCLUSION: The incidence of tracheal aspiration of liquid diet is significantly decreased in the supine position compared to the sitting position. The supine position would be safer than the sitting position in the feeding of liquid diet.

Relationship between the Type of Laryngeal Penetration and Severity of Tracheal Aspiration in the Brain Injured

OBJECTIVE: To assess the incidence of tracheal aspiration in the brain injury patients with laryngeal penetration, and to investigate the relationship between the type of laryngeal penetration and the severity of tracheal aspiration. METHOD: One hundred videofluoroscopic swallowing tests in brain injury patients who showed laryngeal penetration were analyzed retrospectively. Laryngeal penetrations were classified into three groups: anterior, posterior and both. The incidence of the tracheal aspiration among the laryngeal penetration was evaluated. The severity of the tracheal aspiration was analyzed into the three groups: mild, moderate and severe. Each type of the laryngeal penetration were compared with the severity of the tracheal aspiration. RESULTS: Seventy-one patients showed the tracheal aspiration among the 100 patients with laryngeal penetration. The incidence of tracheal aspiration according to the type of the laryngeal penetration was 100% in both, 86.8% in posterior, and 50.9% in anterior type. The more severe tracheal aspiration was associated with the higher proportion of the posterior and both types. CONCLUSION: The incidence of tracheal aspiration in laryngeal penetration was 71%. More severe tracheal aspiration occurred with both & posterior laryngeal penetration than anterior type.