340 / 412
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).
Table 1.
Frequency of Swallowing Abnormalities in Full Cohort.
Swallowing Indices
Number % of Cohort
Frequency of oral abnormalities
28
22
Frequency of pharyngeal abnormalities
50
45
Frequency of esophageal abnormalities
76
68
Oral abnormalities alone
4
4
Pharyngeal abnormalities alone
9
8
Esophageal abnormalities alone
34
31
Oral and pharyngeal abnormalities
7
6
Oral and esophageal abnormalities
9
8
Pharyngeal and esophageal abnormalities
15
14
Oral, pharyngeal, and esophageal
abnormalities
19
17
No abnormalities
14
13
Frequency of PCR outside 2 SD of norm 10
9
Frequency of PESmax outside
2 SD of norm
20
18
PTT outside 2 SD of norm
19
17
ETT
.
15 seconds
32
29
ETT pill,
.
15 seconds (n = 40)
10
25
Abbreviations: ETT, esophageal transit time; PCR, pharyngeal constriction
ratio; PESmax, pharyngoesophageal segment maximum opening; PTT, phar-
yngeal transit time; SD, standard deviation.
Positioning issues
N: 15
Severity of dysphagia/
health
N: 4
Not indicated
N: 3
Timer/calibration
ring missing
N: 13
Included
N: 111
Patients referred for a
videeofluoroscopic
study of swallowing
N: 144
Excluded
N: 35
No esophageal
visualization
N: 22
Received a pill
N: 40
Did not receive a pill
N: 71
Figure 1.
Recruitment inclusion.
Otolaryngology–Head and Neck Surgery 152(3)
115