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Correlation Between Pharyngeal Residue and Aspiration in Fiber-Optic Endoscopic Evaluation of Swallowing: An Observational Study

  • Yael Shapira-Galitz
    Correspondence
    Corresponding author Yael Shapira-Galitz, MD, Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, POB 1 Rehovot 76100, Israel.
    Affiliations
    Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel
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  • Hagit Shoffel-Havakuk
    Affiliations
    Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel

    Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikvah, Israel, affiliated with the Tel Aviv University, Tel Aviv, Israel
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  • Doron Halperin
    Affiliations
    Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel
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  • Yonatan Lahav
    Affiliations
    Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel
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      Abstract

      Objectives

      To examine the correlation between pharyngeal residue severity and clearance to penetration/aspiration on fiber-optic endoscopic examination of swallowing (FEES).

      Design

      Retrospective cohort.

      Setting

      Kaplan Medical Center dysphagia clinic.

      Participants

      Patients (N=110) visiting a dysphagia clinic between 2014 and 2016 undergoing FEES.

      Interventions

      FEES were scored for penetration/aspiration with the Penetration Aspiration Scale (PAS), for residue severity using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). The numbers of swallows required to clear the pharynx were recorded. The first and the worst bolus challenges for each consistency (liquid, purée, solid) were analyzed.

      Main Outcome Measures

      YPR-SRS and number of clearing swallows were correlated with the PAS of the same bolus challenge.

      Results

      The study population’s mean age was 67±13.4 years; 54% were men (n=58). A significant correlation was found between the YPR-SRS and the PAS for all consistencies tested, in each anatomical site (vallecula or pyriform sinus) and for both the first and worst bolus challenges (P<.001 for all). The correlation of residue with aspiration was stronger when vallecula and pyriform sinuses scores were summated (Pearson product-moment correlation coefficient=0.573/0.631/0.446 for liquid/purée/solid for worst bolus challenge). Incorporating the number of clearing swallows to the YPR-SRS strengthened the correlation with PAS.

      Conclusions

      Residue severity and clearance correlate with penetration/aspiration on FEES. The YPR-SRS can be applied to standardize description of residue in FEES and to aid in dysphagia evaluation.

      Keywords

      List of abbreviations:

      BRACS (Boston Residue and Clearance Scale), FEES (fiber-optic endoscopic examination of swallowing), PAS (Penetration Aspiration Scale), PCC (Pearson product-moment correlation coefficient), YPR-SRS (Yale Pharyngeal Residue Severity Rating Scale)
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