Authors (including presenting author) :
Andrew AU YC (1), Irene KWOK CL (1), Reese LEE KY (2), Jeanne FONG WS (1), Ivy LEUNG PF (3), Lisa WONG LS (4), Florence CHING LM (4), Jeffrey CHIU LF (4)
Affiliation :
(1)Speech therapy department, Queen Elizabeth Hospital, (2)Speech therapy department, Buddhist Hospital, (3)Dietetics, Buddhist Hospital, (4)Radiology & Imaging, Buddhist Hospital
Introduction :
Dysphagia is defined by difficulty in the formation and transition of food/liquid bolus from the oral cavity to the esophagus. Modification of diet texture and liquid consistency is indicative to mitigate misdirection of food and liquid into the airway. Non-oral feeding is often recommended to patients presenting with severe dysphagia in view of significant risk of aspiration on oral intake. VFSS is recommended if objective evaluation and interpretation of patients’ swallowing function is indicated following bedside swallowing assessment. VFSS is one of the most widely used instrumental examination conducted by speech therapists in Hospital Authority to assess the efficiency and safety of the swallowing act. VFSS is the global gold standard for the diagnosis and management of oropharyngeal dysphagia. It offers an objective evaluation of the oral, pharyngeal, and cervical esophageal phases of swallowing with clear visualization of the airway condition before, during and after the swallow. Not only does it detect the presence and timing of aspiration, VFSS also provides information pertaining to the physiological causes of the aspiration.
Objectives :
This retrospective study aimed at comparing the recommendations on the mode of feeding and diet textures upon clinical bedside swallowing assessment with those indicated after VFSS. This study also helped to reinstate the significance of VFSS procedure in diagnosing penetration and aspiration risks particularly in case of silent aspiration.
Methodology :
A total of 109 VFSS examinations conducted between September 2018 and December 2020 were reviewed in this study. These patients were referred to speech therapists for swallowing assessment by their respective case doctors. VFSS was indicated when there was possible risk of aspiration especially when silent aspiration was suspected during bedside swallowing examination. Recruited patients had VFSS performed on an average of 4 days post bedside swallowing assessment. Performance in oral, pharyngeal, and cervical esophageal phases was evaluated according to the framework of Modified Barium Swallow Impairment Profile (MBSImP™). MBSImP™ is an evidence-based and standardized protocol in interpretation of physiologic impairment of swallowing function. The depth and response to airway invasion during VFSS were characterized and documented with an 8-point penetration-aspiration scale. Paired sample t-test was used to assess statistical relationship between the clinical bedside swallowing assessment and VFSS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false positive rate and false negative rate were calculated.
Result & Outcome :
Both clinical bedside swallowing assessment and VFSS examination are indispensable in determining the nature and degree of swallowing difficulty. Paired sample t-test results showed significant differences in the recommended mode of feeding between clinical bedside swallowing assessment and VFSS. On the whole, 56% of patients with tube-feeding were able to resume oral mode of nutrition intake after VFSS. 48% of recruited patients with cerebrovascular disease were suggested to adopt oral feeding mode after VFSS procedure. Clinical bedside swallowing assessment has shown consistency with VFSS findings in identifying patients with severe dysphagia and those with significant risk of aspiration on oral feeding with sound sensitivity and specificity. A low false negative rate provides sound evidence that clinical bedside swallowing assessment helped reduce episodes of any swallowing/ feeding related pneumonia and compromised lung condition. This study demonstrated that VFSS is a valuable and effective investigative procedure not only to ensure safe mode of nutrition intake, but also enhance and maintain patients’ quality of life by maximizing their capability of enjoying eating and swallowing.
