HSC Section 6 Nov2016 Green Book

Otolaryngology–Head and Neck Surgery 152(3)

Patients referred for a videeofluoroscopic study of swallowing N: 144

Table 1. Frequency of Swallowing Abnormalities in Full Cohort.

Swallowing Indices

Number % of Cohort

Frequency of oral abnormalities

28 50 76

22 45 68

Frequency of pharyngeal abnormalities Frequency of esophageal abnormalities

Included N: 111

Excluded N: 35

Oral abnormalities alone

4 9

4 8

Pharyngeal abnormalities alone Esophageal abnormalities alone Oral and pharyngeal abnormalities Oral and esophageal abnormalities Pharyngeal and esophageal abnormalities

No esophageal visualization N: 22

Timer/calibration ring missing N: 13

34

31

Received a pill N: 40

7 9

6 8

15 19

14 17

Oral, pharyngeal, and esophageal abnormalities

Did not receive a pill N: 71

Positioning issues N: 15

No abnormalities

14

13

Frequency of PCR outside 2 SD of norm 10

9

Frequency of PESmax outside 2 SD of norm PTT outside 2 SD of norm

20

18

Not indicated N: 3

19 32 10

17 29 25

ETT . 15 seconds

Severity of dysphagia/ health N: 4

ETT pill, . 15 seconds (n = 40)

Abbreviations: ETT, esophageal transit time; PCR, pharyngeal constriction ratio; PESmax, pharyngoesophageal segment maximum opening; PTT, phar- yngeal transit time; SD, standard deviation.

Figure 1. Recruitment inclusion.

normal limits vs outside normal limits. Data were analyzed using SPSS version 20 (SPSS, Inc, an IBM Company, Chicago, Illinois). Descriptive statistics were used to explore the frequency of swallowing abnormalities. Correlation analy- ses were made using x 2 for categorical variables and Spearman correlations for continuous variables. Multiple logistic regressions were applied to evaluate the associations between esophageal abnormalities and other clinical indices adjusted for confounding variables based on bivariate analy- ses (sex, age, etiology, oral abnormalities, pharyngeal abnormalities, PCR, PESmax, PTT, and aspiration event) and 2-way interactions (esophageal abnormalities and PESmax, esophageal abnormalities and oral abnormalities, and esopha- geal abnormalities and age). First the full model with all con- founding factors was fit, and backward selection was used to select the main effect model. The 2-way interactions were then added to the main effect model one by one for the final model. Excluded Data Thirty-three videos were excluded from analyses. Reasons for exclusion include inadequate positioning, severe aspira- tion precluding completion of the study, and missing mea- surement devices ( Figure 1 ). Excluded cases were significantly older ( P \ .001), more likely to be referred by a speech-language pathologist ( P \ .001), and more likely to have a neurologic condition ( P \ .01) than included cases. Results Sixty-eight percent of the 111 patients had esophageal abnormalities, with 29% of the total cohort having an

esophageal transit time of . 15 seconds. Esophageal phase abnormalities were the most common: 68% vs 45% (phar- yngeal) and 34% (oral) ( Table 1 ). In addition, it was rare for patients to present with isolated oral phase or pharyngeal phase abnormalities (only 4% and 8%, respectively), but one-third of patients demonstrated only esophageal phase abnormalities ( Table 1 ). Referral Sources There were significant differences in age, sex, etiology, and swallowing indices between referral sources ( Table 2 ). However, frequency of esophageal abnormalities was not significantly different (ORL, 73%; SLP, 63%). Associations with Esophageal Abnormalities Table 3 displays the associations between esophageal abnormalities and prolonged ETT, with other clinical indices. There was a significant association between esopha- geal abnormalities and reduced PESmax, with 90% of patients with reduced PESmax opening having concurrent esophageal abnormalities. Esophageal transit time was sig- nificantly associated with age ( r = .218, P \ .05), with an odds ratio of 2.8 for prolonged ETT if a patient was older than 65 years. Oral abnormalities were also significantly associated with prolonged ETT, with 50% of patients with prolonged ETT having oral abnormalities. However, when referral sources were separated, the association was only significant in the SLP cohort (SLP cohort, P \ .05; ORL cohort, P = .237).

115