title: Evaluation of volitional and reflexive swallowing in elderly patients with a history of pneumonia.
abstract: OBJECTIVE
  Precise assessment of the risk of aspiration is critical in older patients with a history of pneumonia. However, the currently popular videofluoroscopic and videoendoscopic examinations of swallowing only evaluate volitional swallowing. A method for quantitative analysis of reflexive swallowing is not yet available.
  
  
  METHODS
  We evaluated volitional swallowing in the sitting position by videoendoscopic examination and then measured the volume of injected water that triggered reflexive swallowing in the supine position in 54 patients with a history of pneumonia and 24 control patients of a similar age who had no history of pneumonia.
  
  
  RESULTS
  The volume of injected water that triggered reflexive swallowing was larger in the pneumonia group than in the control group (mean, 1.64 +/- 0.61 mL versus 0.71 +/- 0.28 mL; p < 0.001). Both impaired volitional swallowing and impaired reflexive swallowing independently correlated with a history of pneumonia.
  
  
  CONCLUSIONS
  The endoscopic supine swallow-evoking test ("ESSET") may detect previously omitted risk factors for aspiration in patients who can volitionally swallow.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kiyohara
authors.forename: Toshiro
authors.initials: T
authors.lastname: Umezaki
authors.forename: Motohiro
authors.initials: M
authors.lastname: Sawatsubashi
authors.forename: Nozomu
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Shizuo
authors.initials: S
authors.lastname: Komune
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003679:Deglutition; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000453:epidemiology; D011015:Pneumonia, Aspiration / Q000503:physiopathology; D012018:Reflex / Q000502:physiology; D053120:Respiratory Aspiration / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D014836:Volition / Q000502:physiology; D014867:Water
chemical_list: D014867:Water