Three tests for predicting aspiration without videofluorography

• Published in: Dysphagia 2003-05, Vol.18 (2), p.126-134
• Main Authors: Tohara, Haruka, Saitoh, Eiichi, Mays, Keith A, Kuhlemeier, Keith, Palmer, Jeffrey B
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Deglutition Disorders - diagnosis; Deglutition Disorders - physiopathology; Dentistry; Female; Fluoroscopy; Humans; Inhalation - physiology; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity
• ISSN: 0179-051X; 1432-0460
• DOI: 10.1007/s00455-002-0095-y

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium). Sixty-three individuals with dysphagia were each evaluated with the three non-VFG tests and a VFSS; 29 patients aspirated on the VFSS. The summed scores of all three non-VFG tests had a sensitivity of 90% for predicting aspiration and specificity of 71% for predicting its absence. The summed scores of the water and food tests (without X-ray) had a sensitivity of 90% and specificity of 56%. These non-VFG tests have limitations but may be useful for assessing patients when VFSS is not feasible. They may also be useful as screening procedures to determine which dysphagia patients need a VFSS.