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Doruk C, Çaytemel B, Şahin E, Kara H, Samancı B, Abay SN, Bilgiç B, Hanağası H, Başaran B, Enver N, Rameau A. Evaluation of Post-Swallow Residue with Visual Analysis of Swallowing Efficiency and Safety in Patients with Idiopathic Parkinson's Disease. EAR, NOSE & THROAT JOURNAL 2023:1455613231210976. [PMID: 38050868 DOI: 10.1177/01455613231210976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Objectives: Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. Methods: This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Results: Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Conclusion: Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.
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Affiliation(s)
- Can Doruk
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
- Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical School, New York, NY, USA
| | - Berkay Çaytemel
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Hakan Kara
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Bedia Samancı
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Sevinç Nisa Abay
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
- Işık University, Istanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Haşmet Hanağası
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Bora Başaran
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Anais Rameau
- Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, NY, USA
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Curtis JA, Borders JC, Dakin AE, Troche MS. Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-18. [PMID: 37343540 DOI: 10.1044/2023_jslhr-23-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). METHOD FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows. RESULTS Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g saltine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. DISCUSSION The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing outcomes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample (N = 39), with most people below the age of 60 years (n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23504325.
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Affiliation(s)
- James A Curtis
- Aerodigestive Innovations Research Lab, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York City, NY
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
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Baijens LWJ, Simon SR. Author's reply to the Letter to the Editor "Intra and interobserver agreement of the Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) in fiberoptic endoscopic evaluation of swallowing (FEES): the importance of observer-tailored training". Eur Arch Otorhinolaryngol 2023; 280:3047-3049. [PMID: 37083818 DOI: 10.1007/s00405-023-07970-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sorina R Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
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Hutcheson KA, Starmer H. Letter to the Editor re: Intra and interobserver agreement of the Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) in fiberoptic endoscopic evaluation of swallowing (FEES): the importance of observer-tailored training. Eur Arch Otorhinolaryngol 2023; 280:3045-3046. [PMID: 36912933 DOI: 10.1007/s00405-023-07902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1445, Houston, TX, 77030, USA.
- Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Heather Starmer
- Department of OHNS/Head and Neck Surgery Divisions, Stanford Cancer Center, Stanford, CA, USA
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Tsubokawa M, Fujitani J, Ashida K, Hayase M, Kobayashi N, Horita C, Sakashita M, Tokunaga T, Hamano T, Kikuta KI, Fujieda S. Potential of Rice-Flour Jelly Made from High-Amylose Rice as a Dysphagia Diet: Evaluation of Pharyngeal Residue by FEES. Dysphagia 2022:10.1007/s00455-022-10529-y. [PMID: 36242646 DOI: 10.1007/s00455-022-10529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
Dysphagia diets are recommended to prevent choking and aspiration in people with dysphagia; however, rice-porridge and mashed rice-porridge, which are used as staple foods for people with dysphagia in Japan, are time-consuming to prepare. The National Agriculture and Food Research Organization has found jelly-like food products made from high-amylose rice-flour (rice-flour jelly) to be easy to prepare with a texture suitable for dysphagia diets. To investigate the potential of rice-flour jelly for the dysphagia diet, we evaluated the amount of pharyngeal residue after swallowing rice-flour jelly using fiberoptic endoscopic evaluation of swallowing and compared it with those of rice-porridge, mashed rice-porridge, and fruit jelly. We enrolled 70 participants (43 males and 27 females, aged 32-96 years, median 74.5 years) and evaluated their pharyngeal residue using the Yale Pharyngeal Residue Severity Rating Scale which includes five levels from I (none) to V (severe). Statistical analysis showed that level I was more common in fruit jelly for vallecula residue and pyriform sinus residue, and level III (mild) was more common in rice-porridge for vallecula residue (p < 0.05). No differences of pharyngeal residue were found in rice-flour jelly or mashed rice-porridge. No significant difference was observed in the number of participants with laryngeal penetration or aspiration. Therefore, rice-flour jelly is a suitable alternative to rice-porridge as a staple food for people with dysphagia in terms of food texture.
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Affiliation(s)
- Misao Tsubokawa
- Department of Rehabilitation Medicine, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Junko Fujitani
- Department of Rehabilitation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kanae Ashida
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-12, Kannondai, Tsukuba City, Ibaraki, 305-8642, Japan
| | - Mika Hayase
- Nutrition Department, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Namiko Kobayashi
- Department of Rehabilitation Medicine, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Chika Horita
- Department of Rehabilitation Medicine, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Masafumi Sakashita
- Department of Otorhinolaryngology and Head & Neck Surgery, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
- Medical Research Support Center, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Takahiro Tokunaga
- Research Promotion Office, Shinseikai Toyama Hospital, 89-10, Shimowaka, Imizu City, Toyama, 939-0243, Japan
- Medical Research Support Center, Fukui University Hospital, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tadanori Hamano
- Department of Neurology, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology and Head & Neck Surgery, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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Curtis JA, Borders JC, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): Establishing Criterion-Referenced Validity and Concurrent Validity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:808-818. [PMID: 35077197 DOI: 10.1044/2021_ajslp-21-00116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The primary aim of this study was to examine the criterion-referenced validity of the Visual Analysis of Swallowing Efficiency and Safety (VASES). As a secondary aim, we examined the concurrent validity of using verbal numerical ratings for VASES as a potential substitute for visual analog scale ratings. METHOD Fifty-seven novice raters were prospectively recruited to rate 26 flexible endoscopic evaluations of swallowing (FEES) images (2 times each, randomized)-once using VASES and once using a criterion-referenced scale. Ratings were made for the valleculae, piriforms, epiglottis, laryngeal vestibule, vocal folds, and subglottis. Criterion validity was determined by examining the correlation between VASES and the criterion-referenced scales. The novice raters also provided visual analog scale ratings following verbal numerical ratings. Concurrent validity of using verbal numerical ratings as a potential substitute for visual analog scale ratings was determined by examining the correlation and absolute agreement between both rating methods. RESULTS Three thousand five hundred eighty-seven ratings were analyzed. Spearman's correlation revealed strong correlations between VASES ratings and criterion-referenced ratings across all anatomic landmarks (ρ = .882-.915). Lin's concordance revealed substantial agreement between numerical ratings and visual analog scale ratings (ρc = .986). CONCLUSIONS The strong correlations between VASES and the criterion-referenced scales suggest that VASES is a valid method for interpreting pharyngeal residue, penetration, and aspiration during FEES. Furthermore, numerical ratings exhibited substantial agreement with visual analog scales. This suggests that clinicians could provide verbal numerical ratings in lieu of visual analog scale ratings as a potential way to enhance the ease and feasibility of implementing VASES into clinical practice. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.18737072.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Magalhães Junior HV, Pernambuco LDA, Cavalcanti RVA, Silva RGD, Lima KC, Ferreira MAF. Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults. Gerodontology 2021; 39:418-424. [PMID: 34913514 DOI: 10.1111/ger.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.
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Affiliation(s)
| | | | | | - Roberta Gonçalves da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (Unesp), School of Philosophy and Sciences, Marília Universtiy of São Paulo, Marília, Brazil
| | - Kenio Costa Lima
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
| | - Maria Angela Fernandes Ferreira
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
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Starmer HM, Arrese L, Langmore S, Ma Y, Murray J, Patterson J, Pisegna J, Roe J, Tabor-Gray L, Hutcheson K. Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1802-1810. [PMID: 34033498 DOI: 10.1044/2021_jslhr-21-00014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as bolus-level penetration-aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes research. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results Interrater reliability was almost perfect for overall DIGEST-FEES grade (κw = 0.83) and safety grade (κw = 0.86) and substantial for efficiency grade (κw = 0.74). Intrarater reliability was excellent for all raters (0.9-0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory (r = -.43, p < .0001), Functional Oral Intake Scale (r = -.43, p < .0001), Secretion Severity Scale (r = .47, p < .0001), Yale Vallecular Residue (r = .73, p < .0001), and Yale Pyriform Sinus Residue (r = .65, p < .0001). Conclusion DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC. Supplemental Material https://doi.org/10.23641/asha.14642787.
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Affiliation(s)
| | - Loni Arrese
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | | | | | | | | | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lauren Tabor-Gray
- Phil Smith Neuroscience Institute, Holy Cross Health, Fort Lauderdale, FL
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Atar Y, Atar S, Ilgin C, Anarat MEA, Uygan U, Uyar Y. Validity and Reliability of the Turkish Translation of the Yale Pharyngeal Residue Severity Rating Scale. Dysphagia 2021; 37:655-663. [PMID: 34021774 DOI: 10.1007/s00455-021-10316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the validity and reliability of the Turkish translation of the Yale pharyngeal residue severity rating scale. The scale measures the severity of residue in the vallecula and pyriform sinus. The original scale was translated into Turkish by two bilingual English-Turkish translators, and the Turkish version was translated back into English by two qualified professional translators to assess accuracy. The evaluators were divided into two groups (training and no-training) and two subgroups according to their experience. Intra-rater, inter-rater, and intra-class correlation coefficient measurements were analyzed by calculating agreement rates, kappa, and p values. In the analysis of the reliability, intra-class correlation coefficient values in the overall ratings for both the vallecula and the pyriform sinus were 0.9996 (95% CI 0.9992-0.9998) and 0.9997 (95% CI 0.9995-0.9999), respectively (p < 0.01). High agreement (> 95%) and perfect Fleiss kappa values were obtained for the vallecula and pyriform sinus ratings in the inter-rater initial assessments (κ = 0.959 and κ = 0.967, respectively). Perfect kappa values were found in the intra-rater results for both the vallecula and pyriform sinus (α = 0.9959 and κ = 0.9959, respectively). In the inter-rater secondary analysis, the vallecula and pyriform sinus kappa values were perfect (κ = 0.959 and κ = 0.967, respectively). In the intra-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9918 and κ = 1.0 for the vallecula, and κ = 1.0 and κ = 0.9902 for the pyriform sinus, respectively) In the inter-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9507 and κ = 0.9606 for the vallecula, and κ = 0.9836 and κ = 1.0 for the pyriform sinus, respectively). The Turkish translation of the Yale pharyngeal residue severity rating scale demonstrated high validity and reliability scores in determining pharyngeal residue location and value in the fiberoptic endoscopic evaluation of swallowing.
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Affiliation(s)
- Yavuz Atar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey.
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, FTR Kliniği Kat:6 Blok:1, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Ugur Uygan
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
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Characterizing Quality of Life in Caregivers of People with Parkinson's Disease and Dysphagia. Dysphagia 2021; 37:523-532. [PMID: 33991229 DOI: 10.1007/s00455-021-10299-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
Caring for a family member with dysphagia can negatively impact caregiver wellbeing, although little is known about how dysphagia severity or specific symptoms influence this. The purpose of this study was to examine how objective measures of dysphagia in people with Parkinson's disease influenced their caregivers' quality of life. Fifty caregivers (mainly spouses) of people with Parkinson's disease completed a caregiver quality of life survey. Results were compared to medical chart reviews, interviews, and instrumental evaluations of swallowing from the care recipients. Outcomes included caregiver quality of life score, ratings of airway invasion and pharyngeal residue, and Parkinson's disease duration. Descriptive and regression analyses were completed. All caregivers reported reduced quality of life, with 28% having severely disturbed adaptation. Every care recipient with Parkinson's disease demonstrated airway invasion and/or pharyngeal residue. Together, the combination of older care recipient age and longer disease duration was associated with poorer caregiver quality of life [adj. R2 = 0.10-0.12, p = 0.03-0.4]. Neither airway invasion nor pharyngeal residue was related to caregiver quality of life (p > 0.05). Findings confirmed that caregivers of people with Parkinson's disease and dysphagia experience reduced quality of life; however, current methods of assessing caregivers' quality of life may not adequately account for dysphagia-specific burden. Results highlight the urgent need for the development of dysphagia-specific assessments of caregivers' quality of life to facilitate identification of high-risk caregivers and aid the development of support systems to improve health outcomes for caregivers and care recipients.
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Curtis JA, Borders JC, Perry SE, Dakin AE, Seikaly ZN, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES. Dysphagia 2021; 37:417-435. [PMID: 33837841 DOI: 10.1007/s00455-021-10293-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
The primary aim of this study was to describe the development of the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized method to rate pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we explored the feasibility of training novices to interpret FEES using VASES. Literature review and consensus panel discussions were used to develop standardized rules for VASES. A training protocol was developed and criterion ratings were established. Twenty-five novice raters completed VASES training and pre-/post-training assessments. Statistical analyses were used to examine pre- to post-training differences in the accuracy, reliability, and time to rate each video clip using VASES. Four sets of VASES rules were developed, including 'what', 'where', 'when', and 'how' to rate FEES. Large, significant post-training improvements in rating accuracy were observed across all seven VASES outcome measures (Cohen's d range 0.74-1.59). Additionally, inter-rater reliability increased for four of the seven outcome measures, and the amount of time to rate each video clip decreased from 2.6 min pre-training to 1.5 min post-training. VASES is a standardized FEES rating method used to enhance the subjective analysis of pharyngeal residue, penetration, and aspiration. It can be feasibly taught to novice raters with a high level of success and may be an effective method to analyze swallowing safety and efficiency in clinical and research practices. Future research is needed to test the validity of VASES by examining its relationship with other validated FEES rating scales.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Sarah E Perry
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Zeina N Seikaly
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
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Curtis JA, Seikaly ZN, Dakin AE, Troche MS. Detection of Aspiration, Penetration, and Pharyngeal Residue During Flexible Endoscopic Evaluation of Swallowing (FEES): Comparing the Effects of Color, Coating, and Opacity. Dysphagia 2020; 36:207-215. [PMID: 32394024 DOI: 10.1007/s00455-020-10131-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
The aim of this study was to assess the effects of color, coating, and opacity on the detection of aspiration, penetration, and residue during flexible endoscopic evaluations of swallowing (FEES). Thirty dysphagic adults underwent FEES while swallowing five 5 mL thin liquid boluses (1 × each, randomized): white water, blue water, white milk, blue milk, and barium water. To assess the effects of color, blue milk was compared to white milk. To assess the effects of coating, barium, white water, and white milk were compared to each other. To assess the effects of opacity, blue milk was compared to blue water. Videos were blindly analyzed and judged for the presence of pharyngeal residue, penetration, and aspiration. Repeated measures analyses were used to assess differences in the frequency of detection across bolus types. Pharyngeal residue was detected more frequently for liquids that were blue, had a coating effect, or were opaque (p < 0.05) when compared to liquids that were white, did not have a coating effect, or were translucent, respectively. Penetration and aspiration were detected more frequently for liquids that had a coating effect (p < 0.05), but not for liquids that were colored blue or opaque (p > 0.05). Coating appears to be the most important factor detecting thin liquid residue, penetration, and aspiration during FEES. Given these findings, standardized use of boluses that possess a coating effect (e.g., white-dyed water or barium) is highly recommended to enhance the sensitivity of identifying impairments in swallowing safety and efficiency during FEES.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike Building, Room 955, New York, NY, 10027, USA.
| | - Zeina N Seikaly
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike Building, Room 955, New York, NY, 10027, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike Building, Room 955, New York, NY, 10027, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Thorndike Building, Room 955, New York, NY, 10027, USA
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