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Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia.

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Title: Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia.
Authors: Hunting, Alexandra1 alexandra.hunting@health.wa.gov.au, Steffanoni, Belinda2, Jacques, Angela3,4, Miles, Anna5
Source: American Journal of Speech-Language Pathology. Nov2023, Vol. 32, p2691-2702. 12p.
Subject Terms: *Comparative studies, Pharynx, Larynx, Deglutition, Respiratory aspiration, Deglutition disorders, Disease incidence, Aspiration pneumonia, Endoscopes, Valsalva's maneuver, Descriptive statistics, Pulmonary function tests, Research funding, Expiratory flow
Abstract: Purpose: Accumulated pharyngo-laryngeal secretions are associated with dysphagia, aspiration, and poor health outcomes. Despite ongoing developments in the evaluation of pharyngo-laryngeal secretions, understanding of the underlying mechanisms is limited. Pathophysiology associated with accumulated secretions is needed to guide tailored, targeted treatment pathways. This study reports the prevalence of accumulated pharyngo-laryngeal secretions in a large acute care caseload and explores the relationship between secretions and aerodigestive function. Method: Consecutive inpatients (N = 222) referred for flexible endoscopic evaluation of swallow (FEES) with suspected dysphagia following assessment by a speech-language pathologist were recruited (43% neurological, 22% neurosurgical, 20% critical care, 15% other), and 250 standardized FEES were completed (222 first FEES, 28 repeat FEES). The assessment protocol included secretion assessment using the New Zealand Secretion Scale (NZSS), pharyngeal squeeze maneuver, laryngeal motor and sensory assessment, Penetration-Aspiration Scale, and Yale Pharyngeal Residue Severity Rating Scale. Urge-to-clear ratings were collected during endoscopy. Cough peak expiratory flow and swallow frequency measures were also collected, as well as clinical outcomes at time of discharge. Results: There was a high incidence of accumulated secretions, with 77% of inpatients having elevated NZSS (Mdn = 3, range: 0-7) and 37% with pooled laryngeal secretions. Accumulated secretions were associated with reduced swallow frequency, reduced laryngeal adductor reflex, impaired pharyngeal squeeze maneuver, and peak expiratory flow. NZSS scores also correlated with swallow measures (Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale) and patient outcomes including diet recommendations at discharge and pneumonia during admission. Conclusions: This large study contributes to evidence associating both sensory and motor impairments with secretion accumulation and aspiration risk. Further exploration of the key physiological mechanisms contributing to accumulated secretions will serve as markers to provide proof of principle for targets for secretion management protocols. [ABSTRACT FROM AUTHOR]
Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia.
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  Data: <searchLink fieldCode="AR" term="%22Hunting%2C+Alexandra%22">Hunting, Alexandra</searchLink><relatesTo>1</relatesTo><i> alexandra.hunting@health.wa.gov.au</i><br /><searchLink fieldCode="AR" term="%22Steffanoni%2C+Belinda%22">Steffanoni, Belinda</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Jacques%2C+Angela%22">Jacques, Angela</searchLink><relatesTo>3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Miles%2C+Anna%22">Miles, Anna</searchLink><relatesTo>5</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22American+Journal+of+Speech-Language+Pathology%22">American Journal of Speech-Language Pathology</searchLink>. Nov2023, Vol. 32, p2691-2702. 12p.
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  Data: *<searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Pharynx%22">Pharynx</searchLink><br /><searchLink fieldCode="DE" term="%22Larynx%22">Larynx</searchLink><br /><searchLink fieldCode="DE" term="%22Deglutition%22">Deglutition</searchLink><br /><searchLink fieldCode="DE" term="%22Respiratory+aspiration%22">Respiratory aspiration</searchLink><br /><searchLink fieldCode="DE" term="%22Deglutition+disorders%22">Deglutition disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+incidence%22">Disease incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Aspiration+pneumonia%22">Aspiration pneumonia</searchLink><br /><searchLink fieldCode="DE" term="%22Endoscopes%22">Endoscopes</searchLink><br /><searchLink fieldCode="DE" term="%22Valsalva's+maneuver%22">Valsalva's maneuver</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Pulmonary+function+tests%22">Pulmonary function tests</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Expiratory+flow%22">Expiratory flow</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Accumulated pharyngo-laryngeal secretions are associated with dysphagia, aspiration, and poor health outcomes. Despite ongoing developments in the evaluation of pharyngo-laryngeal secretions, understanding of the underlying mechanisms is limited. Pathophysiology associated with accumulated secretions is needed to guide tailored, targeted treatment pathways. This study reports the prevalence of accumulated pharyngo-laryngeal secretions in a large acute care caseload and explores the relationship between secretions and aerodigestive function. Method: Consecutive inpatients (N = 222) referred for flexible endoscopic evaluation of swallow (FEES) with suspected dysphagia following assessment by a speech-language pathologist were recruited (43% neurological, 22% neurosurgical, 20% critical care, 15% other), and 250 standardized FEES were completed (222 first FEES, 28 repeat FEES). The assessment protocol included secretion assessment using the New Zealand Secretion Scale (NZSS), pharyngeal squeeze maneuver, laryngeal motor and sensory assessment, Penetration-Aspiration Scale, and Yale Pharyngeal Residue Severity Rating Scale. Urge-to-clear ratings were collected during endoscopy. Cough peak expiratory flow and swallow frequency measures were also collected, as well as clinical outcomes at time of discharge. Results: There was a high incidence of accumulated secretions, with 77% of inpatients having elevated NZSS (Mdn = 3, range: 0-7) and 37% with pooled laryngeal secretions. Accumulated secretions were associated with reduced swallow frequency, reduced laryngeal adductor reflex, impaired pharyngeal squeeze maneuver, and peak expiratory flow. NZSS scores also correlated with swallow measures (Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale) and patient outcomes including diet recommendations at discharge and pneumonia during admission. Conclusions: This large study contributes to evidence associating both sensory and motor impairments with secretion accumulation and aspiration risk. Further exploration of the key physiological mechanisms contributing to accumulated secretions will serve as markers to provide proof of principle for targets for secretion management protocols. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Group: Ab
  Data: <i>Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=173537606
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      – Type: doi
        Value: 10.1044/2023_AJSLP-23-00118
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 12
        StartPage: 2691
    Subjects:
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Pharynx
        Type: general
      – SubjectFull: Larynx
        Type: general
      – SubjectFull: Deglutition
        Type: general
      – SubjectFull: Respiratory aspiration
        Type: general
      – SubjectFull: Deglutition disorders
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      – SubjectFull: Disease incidence
        Type: general
      – SubjectFull: Aspiration pneumonia
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      – SubjectFull: Endoscopes
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      – SubjectFull: Valsalva's maneuver
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Pulmonary function tests
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      – SubjectFull: Research funding
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      – SubjectFull: Expiratory flow
        Type: general
    Titles:
      – TitleFull: Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia.
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            NameFull: Hunting, Alexandra
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            NameFull: Steffanoni, Belinda
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            – D: 01
              M: 11
              Text: Nov2023
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              Y: 2023
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