Can the Repetitive Saliva Swallow Test Predict Airway Invasion in All Cause Dysphagia?

Area of Science:

• Otolaryngology
• Neurology
• Gastroenterology

Background:

• The repetitive saliva swallow test (RSST) is a noninvasive screening tool for oropharyngeal dysphagia.
• It is validated for detecting aspiration in neurogenic dysphagia.

Purpose of the Study:

• To evaluate the diagnostic performance of the RSST in predicting airway invasion in an all-cause dysphagia population.
• To compare RSST results against fiberoptic endoscopic evaluation of swallowing (FEES) as the gold standard.

Main Methods:

• Retrospective review of 87 adult outpatients from a dysphagia clinic.
• Patients underwent both RSST and FEES.
• Primary outcome: RSST diagnostic performance for FEES-determined airway invasion (PAS ≥ 3).

Main Results:

• Median RSST score was 5; 32% had airway invasion on FEES.
• Higher RSST scores correlated with lower likelihood of airway invasion (OR: 0.79, p=0.03).
• RSST showed an AUC of 0.64, with optimal cutoff ≤ 6 swallows (89% sensitivity, 34% specificity).

Conclusions:

• The RSST is statistically compatible for screening airway invasion in all-cause dysphagia.
• High cutoff values limit clinical utility due to modest specificity.