Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration.
OBJECTIVE
This study evaluated the clinical significance of pharyngeal retention to predict aspiration in patients with dysphagia.


METHODS
At videofluoroscopy, pharyngeal retention was found in 108 (28%; 73 males, 35 females; mean age, 60 years) of 386 patients with a suspected deglutition disorder. Swallowing function was assessed videofluoroscopically. The amount of residual contrast material in the valleculae or piriform sinuses was graded as mild, moderate, or severe. The frequency, type, and grade of aspiration were assessed.


RESULTS
Pharyngeal retention was caused by pharyngeal weakness or paresis in 103 (95%) of 108 patients. In 70 patients (65%) with pharyngeal retention, postdeglutitive overflow aspiration was found. Aspiration was more often found in patients who had additional functional abnormalities such as incomplete laryngeal closure or impaired epiglottic tilting (p < 0.05). Postdeglutitive aspiration was diagnosed in 25% patients with mild, in 29% with moderate, and in 89% with severe pharyngeal retention (p < 0.05).


CONCLUSIONS
Postdeglutitive overflow aspiration is a frequent finding in patients with pharyngeal retention, and the risk of aspiration increases markedly with the amount of residue. Functional abnormalities other than pharyngeal weakness, such as impaired laryngeal closure, may contribute to aspiration.
Eisenhuber
Edith
E
Department of Radiology and Ludwig Boltzmann-Institute for Clinical and Experimental Radiologic Research, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Schima
Wolfgang
W
Schober
Ewald
E
Pokieser
Peter
P
Stadler
Alfred
A
Scharitzer
Martina
M
Oschatz
Elisabeth
E
D003680:Deglutition Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D014741:Video Recording