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- Steele: Financial disclosures for Dr. Editorial board member, Journal of Texture Studies; Consulting relationship speaker honoraria and advisory panel with Nestle Health Science; Consulting relationship advisor with Benitec Biopharma. Bonnie...
- This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. Objective: This systematic review evaluated the diagnostic validity of different methods for...
- The test named Videofluroscopic Swallowing Study VFSS , which consists of asking a patient to swallow different foods and liquids that contain a radiopaque contrast agent while observed by a trained professional is often considered the standard reference to determine of dysphagia exists. However, frequent VFSS test repetitions are not recommended due to high radiation exposures. Swallowing sounds have been widely associated with pharyngeal reverberations arising from opening and closing of valves oropharyngeal, laryngeal and esophageal valves , action of numerous pumps pharyngeal, esophageal, and respiratory pumps and vibrations of the vocal tract. Based on the above, the aim of this systematic review was to answer the focused question: "What is the diagnostic validity of different methods for assessment of swallowing sounds, when compared to VFSS, for detecting oropharyngeal dysphagia?
- Eligibility criteria We have included diagnostic validity studies, which used different methods for assessment of swallowing sounds compared to the reference standard: videofluoroscopy VFSS. Different methods for assessment of swallowing sounds could include ultrasound, acoustic analysis, cervical auscultation, swallowing accelerometers signals, and the Doppler effect. Previous studies from all languages and with no restrictions regarding age, sex and time of publication were included. Exclusion criteria Articles were excluded from review based on the following criteria: 1 Studies in animals; 2 Studies that did not perform ultrasound, acoustic analysis, cervical auscultation, swallowing accelerometers signals or Doppler effect; 3 Studies that did not compare methods of diagnosis of swallowing for both control and dysphagic group with the VFSS reference standard; 4 Studies that did not present validity measurements sensitivity and specificity or did not present data enough to calculate them; 5 Reviews, letters, conference, abstract, personal opinions.
- More information on the search strategies is provided in Appendix 1. Furthermore, the reference lists of the selected articles were inspected for additional literature. Relevant papers on this topic were also requested from experts in the field. We conducted all searches on October 8th, An updated search with the same word combinations for each database above mentioned was performed on January 25th, Study selection Two independent reviewers K. Studies which did not appear to meet the eligibility criteria were excluded. Next, they independently screened full texts of this initial set of articles.
- Any disagreements were resolved through discussion or referral to a third author B. Data collection process Data extraction was performed by one author K. Disagreements were resolved through discussion. A third author B. Data items The data collected consisted of study authors, year of publication, country, design, mean age and range, sample size, number of patients, number of observations, index test, reference test, description, outcomes, and conclusions. Efforts were made to contact the authors to recover any unpublished data, if the required data were not complete. Two independent reviewers K. Disagreements by discussion with a third author B. Figures of the risk of bias assessment for all included studies were generated with Review Manager 5. Summary measures Sensitivity and specificity of the diagnostic tests were the main outcomes evaluated. The cutoff values used to interpret these data are presented in Appendix 2.
- Synthesis of results Cochrane Collaboration guidelines 20 was used to combine individual results by means of a systematic review, with Restricted Maximum-Likelihood REML estimation and the DerSimonian pooled method. All statistical analysis was crude, without adjustment for potential confounders. Some of the required data were not specified in the articles, so we calculated them. Review Manager 5. After removing the duplicates, a comprehensive evaluation of the abstracts was performed and articles were excluded, resulting in 25 articles for full-text reading. Grey literature search identified studies, where none of the studies were selected.
High-Flow Nasal Cannula (HFNC): Does It Increase Dysphagia & Aspiration Risk?
Also, after hand-search of the reference lists and articles provided by experts, no additional studies were included. Figure 1 Flow diagram of literature search and selection criteria. Twenty-two of them were excluded Appendix 3. Finally, three studies remained and were included in the qualitative synthesis. Study characteristic The three included studies were published in , , and They were conducted in Brazil, 22 Japan 23 and United Kingdom. The index tests used were microphone 23 stethoscope with a microphone inserted into tubing at the bifurcation 24 and sonar Doppler. Abdulmassih et al. Jayatilake et al. The liquid bolus volumes in the reference test varied from 3 24 to 70 mL.- The first 5ml tsp. For each of the protocol's remaining 11 swallow trials, the OI score is based on the initial swallow of each trial. The exception are the sequential swallow tasks trials 4 and 7 , during which each swallow is to be considered in formulating the OI score. Residue is scored after the sequential swallowing task is completed. Penetration and Aspiration Score PAS Physiologic impairment and PAS scores are both important but different types of clinical information and should be evaluated in tandem.
- Lip Closure Score a 0 if there is no labial escape of the bolus between the lips. Score a 1 if there is interlabial escape, but no progression to the anterior lip. Score a 2 if there is escape from the interlabial space or lateral juncture with no extensions beyond the vermillion border of the lower lip. Score a 3 if there is escape of contrast material to the mid chin and a 4 if there is profuse spilling or escape of even small amounts beyond the mid-chin through the open lips. However, demonstration of the ability to control a bolus in the oral cavity is of diagnostic and prognostic value when planning treatment strategies. Score a 1 if the bolus goes to either or both of the lateral sulci or the floor of mouth, or is spread diffusely throughout the oral cavity. Score a 2 if any portion less than half of the bolus passes through the tongue-palate seal and a 3 if more than half of the bolus enters the pharynx.
- Score a 1 if the patient demonstrates slow and prolonged chewing and mashing, but complete recollection or formation of the bolus is achieved. Score a 2 if the bolus is not formed and pieces remain in the oral cavity after the initial swallow. If the patient continues to chew after the first swallow, it is likely that solid pieces remained unchewed and therefore receives a score of 2. A score of 3 reflects minimal chewing and mashing with a majority of the bolus remaining unchewed. If a patient is slow and repetitive, the component is scored as 3. A patient receives a score of 4 if there is minimal or no observable movement. Oral Residue Complete clearance is no observable barium remaining in the oral cavity 0. Trace residue resembles an outline of coated structures 1. It may be difficult to identify trace residue on the video clip depending on the resolution of your computer screen. A majority is more than half of the original bolus remaining and should be given a score of 3.
Diagnostic Validity Of Methods For Assessment Of Swallowing Sounds: A Systematic Review
A score of 4 is minimal or no clearance of the bolus from the oral cavity. Scores of 3 and 4 are relative to the bolus size. Initiation of the pharyngeal swallow based on the position of the bolus head leading edge at the time of first initiation of the brisk, superior-anterior hyoid trajectory. Small movements of the hyoid that occur during chewing, bolus manipulation or tongue stabilization should not be confused with the onset of brisk hyoid motion that is the first structural movement signaling the onset of the pharyngeal swallow.MUSC ENT E-Update: Standardized Measurement And Modeling Oropharyngeal Swallowing Impairment
A score of 0 is represented by the bolus head at the region of the posterior angle of the ramus and back of the tongue at the first sign of hyoid excursion. A score of 1 is indicated by the bolus head at the valleculae at the time of first hyoid excursion. A score of 2 occurs when the bolus head is at the posterior laryngeal surface of the epiglottis at first onset of hyoid excursion i. A score of 3 is represented when the bolus head is in the pyriform sinus at the time of first hyoid excursion and a score of 4 is indicated by no appreciable initiation at any bolus location. Soft Palate Elevation A score of 0 illustrates no bolus between the soft palate and pharyngeal wall. A score of 1 represents a trace column of contrast or air between the soft palate and pharyngeal wall. A score of 2 represents escape of contrast material to the level of nasopharynx.Not The Blog Post I Wanted To Write About MBSImP Training - Dysphagia Cafe
A score of 3 represents escape of contrast material that progress to the level of the nasal cavity and a score of 4 represents escape of contrast material progressing to the level of the nostril with and without nasal emission. Laryngeal Elevation judged during initial elevation of the larynx and prior to the height of the swallow. Laryngeal elevation is scored at the time the epiglottis reaches a horizontal position.Professors Warned About Popular Learning Tool Used By Students To Cheat
If there is no displacement of the epiglottis to a horizontal position, laryngeal elevation is scored just after initial hyoid motion signaling the onset of the pharyngeal swallow when the larynx first moves upward. A score of 0 is represented by full superior movement of the thyroid cartilage that results in complete approximation of the arytenoids to the epiglottic petiole. A score of 1 is represented by partial superior movement of the thyroid cartilage resulting in partial approximation of the arytenoids to the epiglottic petiole. Minimal superior movement of the thyroid cartilage resulting in minimal approximation of the arytenoids to the epiglottic petiole is scored as 2.MBS Measurement Tool For Swallow Impairment—MBSImp Flip EBook Pages 1 - 14| AnyFlip | AnyFlip
A score of 3 is illustrated by no superior movement of the thyroid cartilage and no approximation of the arytenoids to the epiglottic petiole. Anterior Hyoid Excursion judged at the height of the swallow. A score of 0 is complete anterior hyoid movement. Complete anterior displacement corresponds with a more acute angle between the thyroid cartilage and hyoid bone and the height of anterior hyoid movement. A score of 1 is partial anterior movement often characterized as the thyroid cartilage being in a more direct line with the hyoid and the height of anterior hyoid movement. A score of 2 is no anterior movement of the hyoid bone. Epiglottic Movement is judged at the height of the swallow at the point of maximal epiglottic movement. A score of 0 is complete inversion of the epiglottis, while a score of 1 is movement of the epiglottis to a horizontal position with no progression beyond the horizontal position.Modified barium swallow study training - ZoneAlarm Results
A score of 1 would also be given if the epiglottis moves inferiorly but does not reach a horizontal position. A score of 2 is minimal to no movement of the epiglottis Laryngeal Vestibular Closure is judged at the height of the swallow point of maximal anterior hyoid movement and maximal laryngeal vestibular closure. Complete laryngeal vestibular closure with no air or contrast in the laryngeal vestibule is scored as 0. A score of 1 is characterized by a narrow column of air or contrast in the laryngeal vestibule, and a score of 2 is characterized by a wide column of air or contrast in the laryngeal vestibule. Note: Patients may but not always demonstrate entry of contrast into the laryngeal vestibule during early laryngeal elevation receiving a score of 1 , but completely or partially expel the penetrated material at the height of the swallow and receive a score of 0. Pharyngeal Stripping Wave is judged along the full length of the pharyngeal wall from the nasopharynx to the PES.
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