Aspiration: diagnostic contributions from bedside swallowing evaluation and endoscopy

Area of Science:

• Clinical Medicine
• Otolaryngology
• Speech-Language Pathology

Background:

• Aspiration, the inhalation of foreign material into the airway, is a significant risk in patients with dysphagia.
• Accurate identification of risk and protective factors for aspiration is crucial for effective clinical management.
• Bedside swallowing evaluation (BSE) and fiberoptic endoscopic evaluation of swallowing (FEES) are common diagnostic tools.

Purpose of the Study:

• To determine which clinical characteristics identified via BSE and FEES serve as risk or protective factors for aspiration.
• To provide clinicians with a better understanding of airway protection mechanisms during swallowing.

Main Methods:

• Retrospective analysis of data from 1577 patients undergoing BSE and FEES.
• Bivariate analysis (Chi-Square test) to assess the association of variables with aspiration.
• Multivariate logistic regression to quantify the association of significant variables with aspiration.

Main Results:

• Several variables were significantly associated with aspiration (p < 0.05).
• Protective factors identified include cooperation, sensation, laryngeal elevation, and direct therapy.
• Tracheotomy, material pooling, and spillage were identified as risk factors.
• Patients performing dry swallows had a 77% reduced likelihood of aspiration.

Conclusions:

• Clinical findings from BSE and FEES provide valuable insights into aspiration risk.
• Understanding the interplay of protective factors like cooperation and laryngeal function is key to airway protection.
• These findings enhance the clinician's ability to interpret swallowing evaluations and manage aspiration risk.