Clinical Association Between Nasopharyngeal Reflux and Aspiration

Nasopharyngeal reflux (NPR) is a disturbing phenomenon which interferes swallowing, and the occurrence of NPR is known to be related to aspiration prevalence. The aim of this study is to verify a hypothesis that aspiration will occur more severely in patients with severe NPR, and when it occurs before NPR. Through 2650 video review of videofluoroscopic swallowing study (VFSS) conducted between January 2013 and July 2017 in a tertiary hospital, 100 patients who presented with NPR (NPR group) and age/sex-matched 100 non-NPR patients were screened. The severities of NPR and that of aspiration were analyzed by using final refluxed space and Penetration-Aspiration Scale (PAS) scores. The mean PAS score was significantly higher in the NPR group than in the non-NPR group (p = 0.01). The mean PAS score was significantly high in patients who had a higher NPR grade (p < 0.01). The PAS score was higher when aspiration occurred before NPR (p = 0.02), whereas NPR was more severe when NPR preceded aspiration (p = 0.01). A high index of suspicion is necessary in patients with regurgitating symptom toward the nasopharynx and nasal cavity. Since the severity of the NPR and that of aspiration may differ according to the order of occurrence, biomechanical study through VFSS is important.