Dysphagia Evaluation

Aka: Dysphagia Evaluation, Swallowing Evaluation for Oropharyngeal Dysphagia, Swallowing Exam, Dysphagia after Cerebrovascular Accident, Swallowing Evaluation after Stroke, Bedside Swallow Assessment, Bedside Swallowing Exam, Video Fluoroscopic Swallowing Study, Fiber-Optic Endoscopic Swallowing Study, Endoscopic Swallowing Evaluation

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II. Epidemiology

  1. Oropharyngeal Dysphagia may occur in 55% of patients after CVA
    1. Silent aspiration occurs 40-70% of Oropharyngeal Dysphagia patients
    2. Risk of Aspiration Pneumonia and other complications

III. Prognosis: Predictors of Aspiration Risk after CVA

  1. Criteria
    1. Dysphonia
    2. Dysarthria
    3. Abnormal Gag Reflex
    4. Abnormal volitional cough (weak cough on command)
    5. Cough within 1 minute of water ingestion (5,10,20 cc)
    6. Voice changes after Swallowing (5, 10, 20 cc)
  2. Interpretation
    1. One or less criteria: Mild or no Dysphagia
    2. Two or more criteria: Moderate to severe Dysphagia

IV. History

  1. See Dysphagia

V. Exam: Bedside Swallow Assessment

  1. See Dysphagia
  2. Performed by trained observer (esp. speech pathology)
    1. Hospital nurses typically perform an initial bedside water swallow screen after suspected CVA and before patient eats
  3. Water Swallowing test
    1. Patient drinks 5-30 ml of water (or repeatedly swallows their own Saliva)
    2. Examiner observes for coughing, Choking or congested voice on Swallowing
    3. Oxygen Saturation may be performed at same time
      1. Observe for 2-3% desaturation after Swallowing
  4. Various viscosities of food and liquid are trialed
    1. Patient observed after Swallowing a thin liquid, a thick liquid, a puree and a solid food
    2. Examiner observes for coughing, Choking or congested voice on Swallowing
    3. Examiner also observe for piecemeal Swallowing (patient requires multiple swallows for each bolus)
    4. As with water swallow, Oxygen Saturation may be observed for 2-3% desaturation after Swallowing

VI. Imaging: Video Fluoroscopic Swallowing Study

  1. First-line imaging study indicated in faile bedside Swallowing assessment
  2. Accurately measures presence and degree of aspiration with Swallowing
  3. Modified barium swallow performed in radiology suite by radiologist and speech pathology

VII. Imaging: Fiber-Optic Endoscopic Swallowing Study

  1. Adjunctive study to Video Fluoroscopic Swallowing Study
  2. Identifies bolus residue (and aspiration residue) in the pharynx and Larynx
  3. May be used to observe patient-specific efficacy of preventive maneuvers with various food and liquid consistencies
  4. Minimally invasive study performed by speech pathology typically in combination with medical provider review

VIII. Evaluation: Screening Tools

  1. Eating Assessment Tool or EAT-10 (Nestle)
    1. https://www.nestlehealthscience.com/health-management/gastro-intestinal/dysphagia/eat-10
    2. Belafsky (2008) Ann Otol Rhinol Laryngol 117(12):919-24 +PMID:19140539 [PubMed]
  2. What About Swallowing?
    1. See Dysphagia
    2. Standard Dysphagia history is as effective as EAT-10 questionnaire
    3. Heijnen (2016) Dysphagia 31(2):214-22 +PMID:26753926 [PubMed]
  3. Swallowing Quality of Life Questionnaire (SWAL-QOL)
    1. Requires purchase of Questionnaire
  4. Sidney Swallow Questionnaire
    1. https://stgeorgeswallowcentre.org/sydney-swallow-questionnaire/
    2. Dwiveldi (2010) Oral Oncol 46(4):e10-4 +PMID:20219415 [PubMed]

IX. Management: Moderate to Severe Dysphagia

  1. See Oropharynngeal Dysphagia
  2. See Dysphagia Diet

X. References

  1. Daniels (2000) Arch Phys Med Rehabil 81:1031 [PubMed]
  2. Wilkinson (2021) Am Fam Physician 103(2): 97-106 [PubMed]

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