Fibroscopic evaluation of swallowing

Abstract

Introduction. Oropharyngeal dysphagia is a frequent pathological condition, specially in the elderly. It is associated to several diseases (mainly neurological and traumatic) and it carries a risk of pneumonia and aspiration. Fibroscopic evaluation of swallowing allows the study of the physiology of swallowing, the assessment of aspiration risk, and enables counseling as to the safest way to feed the patient. Aim. To review the experience in fibrocopic evaluation of swallowing in our institution Material and method: Seventy five patients were prospectively evaluated between April 2006 and July 2007, for a total of 96 fibroscopies. Two-thirds of the evaluated patients were males, with an average age of 65.6± 23.3 years (ranging from 12 to 99 years). Examination was made by means of a flexible nasopharyngoscope while administering food (purée and thick liquid) stained with a natural blue dye. Findings were registered in a custom-designed data sheet, emphasizing the presence of laryngeal penetration and tracheal aspiration of food. Results. The more frequent diagnoses were neurological (54.7%), with a predominance of cerebrovascular pathology, cranial trauma and degenerative neurological pathology. Only 17.8% of evaluations were considered completely normal. The most frequent alteration was the presence of post-swallowing food residues (79.3%); laryngeal penetration and tracheal aspiration were demonstrated in 46.1% and 27.3% of evaluations, respectively. Both the presence of tracheostomy and of hypopharyngeal secretion retention were significantly associated to food residues presence. An association between the patient s diagnosis and the aspiration severity failed to be demonstrated. No complications were reported during examination. Conclusion. Swallowing evaluation by fibroscopy is a validated, safe and sensitive examination technique for the evaluation of oropharyngeal dysphagia. It has the advantage of easy-to-carry equipment and no need to radiation exposure. The need to use standard consistency food, a common datasheet to record findings and uniform criteria for the interpretation of the findings is stressed.