Association between Swallowing-Related Questionnaire Responses and Pathological Signs on Videofluoroscopy in Children (original) (raw)
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CoDAS, 2015
Purpose: To verify the accuracy of clinical evaluation compared with videofluoroscopic swallowing studies in the detection of isolated laryngeal penetration and laryngeal aspiration in children with suspected dysphagia; to identify clinical signs and symptoms associated with isolated laryngeal penetration and laryngeal aspiration; and to determine the sensitivity and specificity of the clinical signs and symptoms identified. Methods: Retrospective analysis of data from clinical and videofluoroscopic evaluations carried out in 55 children from 1 month to 7 years and 11 months old. For clinical assessment, the Protocol for Clinical Assessment of Pediatric Dysphagia was used. The sensitivity, specificity, and positive and negative predictive values of clinical evaluation were analyzed. For statistical analysis, the Fisher's exact and χ2 tests were used. Results: Clinical evaluation showed, in general, a sensitivity of 86% and a specificity of 32%. For isolated laryngeal penetration...
Postepy Nauk Medycznych, 2014
Introduction. Swallowing disorders are a relevant but often unrecognized and underestimated problem in children. Sometimes they lead to aspiration pneumonia. Aim. The aim of this study was to show the usefulness of the videofluoroscopic swallowing studies' (VFSS) findings in children with various diseases and symptoms of swallowing disorders based on experiences of the Department of Gastroenterology, Hepatology and Nutrition Disorders in Poland. Material and methods. A total of 36 children were enrolled in this retrospective study. All patients presented swallowing disorders, therefore they were referred to VFSS. Indications for VFSS were defined by a physician and speech-language pathologist. The outcomes were reviewed by a radiologist and speech-language pathologist. Type of feeding, compensation or rehabilitation was recommended by speech-language pathologist. The swallowing problems, VFSS findings and recommendation after examination were analyzed. Results. The reason for VFSS referral was "the safety of swallowing" (17 children) or the assessment the function of swallowing (15 children). For the rest of patients the reason for VFSS was the simultaneous evaluation of the safety and function of swallowing (4 children). 22 children (61%) presented with respiratory symptoms as a cause of swallowing disorders and the necessity for VFSS. Silent aspiration was observed in 15 of patients, aspiration with cough in 2, pharyngeal residue in 6, residue with penetration in 6 of all patients. The VFSS outcomes indicated the necessity to modify oral feeding in 19 children (53%). In 12 patients (33%) oral feeding was discontinued. Rehabilitation without oral feeding was ordered in 13 patient (36%), general swallowing rehabilitation with the oral use of foods in 11 children (30%). Compensation using different food consistency was used in 9 patient (25%), compensation by proper positioning and modified feeding technique was adopted in 16 children (44%). Feeding disorders therapy was ordered in 8 children (22%). Conclusions. This method is helpful for defining and diagnosis the problem with swallowing. VFSS allows to choose a proper therapy and to determine the way of feeding accordingly to different pathophysiologic mechanisms of swallowing disorders in children. S t r e s z c z e n i e Wstęp. Zaburzenia połykania są istotnym, ale często niedocenianym i nierozpoznanym problemem u dzieci. Czasem prowadzą do zachłystowego zapalenia płuc. Cel pracy. Celem pracy jest przedstawienie metod terapeutycznych i efektów wideofluoroskopowej oceny aktu połykania (VFSS) u dzieci z różnymi chorobami i objawami zaburzeń połykania leczonych w Klinice Gastroenterologii, Hepatologii i Zaburzeń Odżywiania w Polsce. Materiał i metody. Do badania retrospektywnego zakwalifikowano 36 dzieci. Wszyscy pacjenci prezentowali zaburzenia połykania, w związku z czym zostali skierowani na badanie VFSS. Wskazania do VFSS zostały określone przez lekarza i logopedę. Wyniki zostały zweryfikowane przez radiologa i logopedę. Sposoby karmienia, kompensacji lub rehabilitacji zostały zalecone przez logopedę. Przeanalizowano problemy z połykaniem, wyniki VFSS oraz zalecenia po badaniu.
International Journal of Pediatric Otorhinolaryngology
In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. Study design: Prospective, observational. Methodology: Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used.Results: FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). Conclusion: FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
Journal of Child Neurology, 2014
To determine whether findings on videofluoroscopic swallow studies reveal different patterns of dysphagia between children with central and peripheral neurologic disorders, a retrospective study of 118 videofluoroscopic swallow studies was completed. There were 3 groups: cerebral palsy with only spastic features (n ¼ 53), cerebral palsy with dyskinetic features (n ¼ 34), and neuromuscular disorders (myotonic dystrophy I, n ¼ 5; spinal muscular atrophy I-II, n ¼ 8; Duchenne muscular dystrophy, n ¼ 8; other neuromuscular disorder, n ¼ 10). Interpretation of the videofluoroscopic swallow studies was not blinded. The video fluoroscopic swallow study findings were compared dichotomously between the groups. Children with cerebral palsy demonstrated dysphagia in 1 or all phases of swallowing. In neuromuscular disorder, muscle weakness results in pharyngeal residue after swallow. The underlying swallowing problem in neuromuscular disorder is muscle weakness whereas that in cerebral palsy is more complex, having to do with abnormal control of swallowing. This study serves as a first exploration on specific characteristics of swallowing in different neurologic conditions and will help clinicians anticipate what they might expect.
Videofluoroscopic swallow study: techniques, signs and reports
Nestlé Nutrition Institute workshop series, 2012
Management of oropharyngeal swallowing dysfunction often requires both a clinical and an instrumental examination. A videofluoroscopic swallowing study is an instrumental examination that often could be a good option and a very useful tool for the swallowing clinician. At Skåne University Hospital, Malmö, Sweden, the name of such examination is therapeutic videoradiographic swallowing study (TVSS). A TVSS examination should always be performed in collaboration between a speech language pathologist and a radiologist. During the examination, the patient is seated in an upright position, but the examination can also be performed with the patient lying down. The TVSS examination can be performed both in frontal and lateral projection. Test material with varied consistencies as well as different therapeutic strategies can be tested during the examination. Any oral and/or pharyngeal dysfunction can be defined, for example a delay in the initiation of the pharyngeal swallow or an absent ph...
Clinical and videofluoroscopic evaluation of swallowing disorders
American Journal of Roentgenology, 1993
Swallowing and feeding problems are common, particularly in elderly persons, and will be an increasing cause of disability as the geriatric population expands. Consequently, the need for clinical and radiologic examinations of patients who have swallowing problems will likely become commonplace. In this review, we define the problem confronting these patients, dlscuss the clinical and videofluoroscopic procedures used to examine patients with swallowing difficulty, and integrate the results of these examinations and their impact on feeding recommendations.
The Videofluorographic Swallowing Study
Physical Medicine and Rehabilitation Clinics of North America, 2008
The evidence for the physiologic foundation and interpretation of the videofluorographic swallowing study (VFSS) is described. The purpose and clinical utility of VFSS are explained. Standardization of the VFSS procedure, protocol, interpretation and reporting is highlighted as a critical step in future clinical practice and in clinical research. Individualized, evidenced -based rehabilitation strategies are presented as key components that are systematically applied during the VFSS procedure and integrated into the swallowing management plan. A new tool that has been developed and tested for the quantification of swallowing impairment is introduced.