Establishment of screening method for diagnosing pharyngeal dysphagia during eating-Establishment of diagnosing criteria for cervical auscultation-

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Cervical auscultation(CA) is frequently used for the clinical assessment of dysphagia. Using CA, respiratory and swallowing sounds of dysphagic patients can be distinguished from those of normal. This study was done to evaluate the accuracy of CA. One of the problems we had in studying swallowing sounds was that there was a difference in sound quality between detected sounds and actual auscultated sounds since we have used an accelerometer to detect swallowing sounds. In this study, we developed a swallowing sound detection system using a microphone. Thirty mixed head and neck post-surgical cancer patients, giving informed consent, served as subjects. During VF examination, respiratory and swallowing sounds were detected by a microphone and recorded to a DV recorder with videofluorographic(VF) images. Thirty sound samples were edited and presented to eight examiners through headphones. Each sound sample included expiratory sounds before swallow, swallowing sounds produced by 5ml barium swallow, and expiratory sounds immediately after swallow. Without videofluorographic images, each examiner auditorily judged the sound samples to one of two categories-safe swallow or dysphagic swallow. To evaluate the accuracy of cervical auscultation, we assessed the percent agreement of auditory judgement with Vf images.The percent agreement of two categories judged auditorily with VF images averaged over 80%. This result revealed the reliability of CA as a clinical tool for diagnosing dysphagic swallow.