Standardization of quantitative evaluation for swallowing disturbance

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Quantitative standardized evaluation of swallowing function is mandatory for treating patients with dysphagia in consideration of their quality of life. However, there has not been any established evaluation criteria for swallowing disturbance. In this study, we aimed to assess the pathological severity of swallowing function of the dysphagic patients multifacetedly and quantitatively, and establish standardized evaluation criteria.Forty-two patients with dysphagia due to cerebrovascular or neuromuscular diseases (35 males and 12 females, mean age : 68.9 years) were enrolled in this study. Their swallowing functions were examined by videoendoscopy and videofluorography. By videoendoscopic observation, 1) salivary pooling in the vallecula and piriform sinuses, 2) glottal-closure reflex, 3) swallowing reflex, and 4) pharyngeal clearance after swallowing 3ml of blue-dye water were scored into 0-3, respectively. By videofluorographic study, pharyngeal clearance after swallowing 5ml of balium was also scored into 0-3, and aspiration was evaluated.The results of scoring of videoendoscopy varied insignificantly among examiners, demonstrating that videoendoscopy can quantitatively evaluate the severity of dysphagia. Pharyngeal clearance by videoendoscopy correlated with pharyngeal clearance or aspiration by videofluoroscopy. In conclusion, 1) salivary pooling in the vallecula and piriform sinuses, 2) glottal-closure reflex, 3) swallowing reflex, and 4) pharyngeal clearance after swallowing 3ml of blue-dye water are useful tools for evaluating swallowing disturbance. And scoring of these parameters can quantitatively evaluate the severity of dysphagia.