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To examine the correlation between pharyngeal residue severity and clearance to penetration/aspiration on fiber-optic endoscopic examination of swallowing (FEES).Retrospective cohort.Kaplan Medical Center dysphagia clinic.Patients (N=110) visiting a dysphagia clinic between 2014 and 2016 undergoing FEES.FEES were scored for penetration/aspiration with the Penetration Aspiration Scale (PAS), for residue severity using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). The numbers of swallows required to clear the pharynx were recorded. The first and the worst bolus challenges for each consistency (liquid, purée, solid) were analyzed.YPR-SRS and number of clearing swallows were correlated with the PAS of the same bolus challenge.The study population's mean age was 67±13.4 years; 54% were men (n=58). A significant correlation was found between the YPR-SRS and the PAS for all consistencies tested, in each anatomical site (vallecula or pyriform sinus) and for both the first and worst bolus challenges (P.001 for all). The correlation of residue with aspiration was stronger when vallecula and pyriform sinuses scores were summated (Pearson product-moment correlation coefficient=0.573/0.631/0.446 for liquid/purée/solid for worst bolus challenge). Incorporating the number of clearing swallows to the YPR-SRS strengthened the correlation with PAS.Residue severity and clearance correlate with penetration/aspiration on FEES. The YPR-SRS can be applied to standardize description of residue in FEES and to aid in dysphagia evaluation.

Objective To assess the jaw-opening force test (JOFT) for dysphagia screening. Design Criterion standard. Setting University dental hospital. Participants Patients complaining of dysphagia (N=95) and with symptoms of dysphagia with chronic underlying causes (mean age ± SD, 79.3±9.61y; range, 50–94y; men: n=49; mean age ± SD, 77.03±9.81y; range, 50–94y; women: n=46; mean age ± SD, 75.42±9.73y; range, 51–93y) admitted for treatment between May 2011 and December 2012 were included. Interventions None. Main Outcome Measures All patients were administered the JOFT and underwent fiberoptic endoscopic evaluation of swallowing (FEES). The mean jaw-opening strength was compared with aspiration (ASP) and pharyngeal residue observations of the FEES, which was used as the criterion standard. Results A receiver operating characteristic (ROC) curve analysis was performed. Forces of ≤3.2kg for men and ≤4kg for women were appropriate cutoff values for predicting ASP with a sensitivity and specificity of .57 and .79 for men and .93 and .52 for women, respectively. Based on the ROC analyses for predicting pharyngeal residue, forces of ≤5.3kg in men and ≤3.9kg in women were appropriate cutoff values, with a sensitivity and specificity of .80 and .88 for men and .83 and .81 for women, respectively. Conclusions The JOFT could be a useful screening tool for predicting pharyngeal residue and could provide useful information to aid in the referral of patients for further diagnostic imaging testing. However, given its low sensitivity to ASP the JOFT should be paired with other screening tests that predict ASP.

Objectives To determine the effect of the chin-down maneuver after esophagectomy with 3-field lymphadenectomy (3FL) on pharyngeal residue, upper esophageal sphincter (UES) opening, and laryngeal closure. Design Prospective data were collected from a pharyngeal videofluoroscopic swallowing study. Setting Dysphagia clinics. Participants Patients selected according to the inclusion criteria (N=14; mean age, 65.9y) from a total of 43 patients who underwent esophagectomy with 3FL from May to December 2014 were enrolled. Interventions Videofluoroscopy was conducted in head-neutral and chin-down positions to measure the pharyngeal constriction ratio (PCR), amount of residue in the vallecula and pyriform sinus after the first swallow, UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure. Main Outcome Measures The aforementioned parameters were compared statistically between the head-neutral and chin-down positions. Results In comparison with the neutral group, the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group ( P P =.44). The UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure were all significantly larger in the chin-down group than in the neutral group ( P Conclusions This study demonstrates that use of the chin-down maneuver after esophagectomy with 3FL can help expedite swallowing by strengthening pharyngeal constriction, widening the UES, and enhancing laryngeal closure.

Objective To investigate the relation between voluntary cough and swallowing functions according to the type of lesion in patients with acute stroke. Design Cross-sectional study. Setting University rehabilitation hospital. Participants Acute stroke patients with dysphagia symptoms (N=397). Interventions Not applicable. Main Outcome Measures A peak cough flow meter was used to measure voluntary coughing ability. Swallowing function was evaluated using the functional dysphagia scale and the penetration-aspiration scale based on the results of a videofluoroscopic swallowing study. Stroke lesions were divided into one of the following 3 categories: cortical, subcortical, and brainstem. These evaluations were performed within 2 weeks after stroke onset. Results Of the enrolled 397 patients, 207 patients were classified as cortical stroke, 106 patients were classified as subcortical stroke, and 84 patients were classified as brainstem stroke. Among the subscores of the functional dysphagia scale, the amount of pharyngeal residue negatively correlated with peak cough flow meter results across all stroke lesion types. In the brainstem lesion, peak cough flow and penetration-aspiration scale scores were high compared with other lesions, but these 2 functions did not show a correlation. Conclusions This study revealed that large amounts of pharyngeal residue correlated with weak voluntary cough ability in all stroke lesion groups. We also showed a discrepancy between 2 functions in the brainstem lesion group. Our results suggest that voluntary coughing exercises could be a helpful therapeutic option for dysphagia to prevent pulmonary complications in some types of patients with stroke.

Wada S, Tohara H, Iida T, Inoue M, Sato M, Ueda K. Jaw-opening exercise for insufficient opening of upper esophageal sphincter. Objective To investigate the effects of the jaw-opening exercise on decreased upper esophageal sphincter (UES) opening while swallowing. Design Intervention study: before-after trial with 4-week follow-up evaluation. Setting A university school of dentistry dental hospital. Participants Patients with dysphagia (N=8; 7 men, 1 woman; average age ± SD, 70.5±11.3y; age range, 54–86y). Interventions All patients performed a jaw-opening exercise to strengthen the suprahyoid muscles. The exercise involved opening the jaw to its maximum and maintaining this position for 10 seconds. Each exercise set consisted of 5 repetitions, and 2 sets were carried out daily for 4 weeks. The effectiveness of the exercise was evaluated by a videofluorographic swallowing study (VFSS). Main Outcome Measures Hyoid elevation, UES opening, pharynx passage time, and pharyngeal residue after swallowing at preexercise and postexercise were compared by VFSS. Results Compared with before starting the exercise, significant improvements were observed in the extent of upward movement of the hyoid bone ( P P P Conclusions The jaw-opening exercise is an effective treatment for dysphagia caused by dysfunction of hyoid elevation and UES opening.

Objective: To identify the incidence, characteristics, treatment strategies, and outcomes for dysphagia after anterior cervical spinal surgery (ACSS). Design: Retrospective, case-controlled. Setting: 2 free-standing rehabilitation hospitals. Participants: All patients admitted to 2 rehabilitation hospitals over 3 years after ACSS. Interventions: Not applicable. Main Outcome Measures: American Speech-Language-Hearing Association National Outcome Measurement System (NOMS) Swallowing Scale, results of instrumental assessment for aspiration, laryngeal penetration, pharyngeal residue, and length of dysphagia treatment. Results: 46 patients were included in this study. Group 1 (n=31) included patients who presented with dysphagia after ACSS. Group 2 (n=15) included patients who presented with no dysphagia after ACSS. Mean age for group 1 was 56.35 years and group 2 was 52.40 years. The difference in age between the 2 groups was not statistically significant (F=.49, P =.487). Traumatic injuries versus nontraumatic injuries were equally represented in each group. In group 1, 32% presented with a concomitant brain injury and in group 2, 22%. A tracheotomy was present in 26% of group 1 subjects as compared with 13% in group 2 subjects. In group 1, 29% had either the SOMI or halo-brace as compared with 6.6% in group 2. In group 1, 61% had a cervical collar as compared with 93% in group 2. In group 1, mean NOMS swallowing level for admission was 2.806 and for discharge was 4.968. Gains made were considered statistically significant (F=17.12, P Conclusion: Dysphagia after ACSS was present in 67.4% of the patients who were admitted to the rehabilitation hospitals. Aspiration, laryngeal penetration, and pharyngeal residue were common findings. These patients demonstrated significant progress with their dysphagia treatment during inpatient rehabilitation.