341 / 412
Discussion
As has been previously reported, there was a high frequency
of esophageal abnormalities observed in this cohort of
patients referred to an SLP-led VFSS clinic.
1
In fact, eso-
phageal phase abnormalities were the most prevalent finding
in all groups regardless of referral diagnosis or source.
Esophageal phase abnormalities were not predicted by other
phase abnormalities. If fluoroscopic screening had involved
the oropharynx alone, one-third of patients would have been
sent home with no diagnosis, and one-third of patients
would have been treated for oropharyngeal dysphagia with-
out consideration of concurrent esophageal disorders. In
agreement with previous manometric data, slower esopha-
geal transit times were found with increasing age.
16
It
could, therefore, be hypothesized that, with the inclusion of
esophageal visualization, two-thirds of patients potentially
had altered clinical recommendations: different diet recom-
mendations, different feeding strategy recommendations,
and additional referrals for further investigations and medi-
cal specialty input. It may also suggest that esophageal tran-
sit time changes with age rather than being a pathologic
Table 2.
Comparison of Referral Sources.
Frequency (% within Referral Type)
Characteristic
ORL
SLP
x
2
P
Value
a
Number of files
59
52
neurological etiology neurological etiology
Age (
.
65 y)
37 (63)
47 (90)
11.50
.001
Sex (male)
20 (33)
31 (60)
7.36
.008
Etiology—neurological
4 (7)
32 (62)
44.01
.000
Dysphagia of unknown cause
27 (46)
10 (19)
ORL (H&N cancer, GERD)
24 (41)
4 (8)
Other (unwell elderly, pneumonia)
4 (6)
6 (11)
Frequency of oral abnormalities
11 (19)
27 (52)
13.60
.000
Frequency of pharyngeal abnormalities
10 (17)
40 (77)
40.16
.000
Frequency of esophageal abnormalities
43 (73)
33 (63)
1.14
.312
Frequency of PCR outside 2 SD of norm
1 (2)
9 (17)
8.26
.006
Frequency of PESmax outside 2 SD of norm
12 (20)
8 (36)
.340
.625
PTT outside 2 SD of norm
7 (12)
12 (23)
2.33
.139
ETT
.
15 seconds
13 (22)
19 (37)
2.83
.099
Aspiration event occurred (Pen-Asp score 6-8)
2 (3)
12 (23)
9.72
.003
Abbreviations: ETT, esophageal transit time; GERD, gastroesophageal reflux disease; H&N, head and neck; ORL, otorhinolaryngology; PCR, pharyngeal con-
striction ratio; Pen-Asp, penetration-aspiration; PESmax, pharyngoesophageal segment maximum opening; PTT, pharyngeal transit time; SD, standard devia-
tion; SLP, speech-language pathology.
a
Bolding indicates that the
P
values have reached significance.
Table 3.
Associations between Esophageal Abnormalities and Other Clinical Indices.
Esophageal Abnormalities
Esophageal Transit Time
.
15 Seconds
Characteristic
x
2
P
Value
x
2
P
Value
a
Age (
.
65 y)
.000
1.000
3.42
.087
Sex (male)
.006
1.000
.298
.675
Etiology
1.645
.678
2.54
.481
Frequency of oral abnormalities
.089
.826
4.96
.030
Frequency of pharyngeal abnormalities
.001
1.000
.446
.504
Frequency of PCR outside 2 SD of norm
.617
.474
.723
.466
Frequency of PESmax outside 2 SD of norm
4.41
.054
.029
1.00
PTT outside 2 SD of norm
.047
1.000
1.89
.266
ETT
.
15 seconds
19.15
.000
20.71
.000
Aspiration event occurred (Pen-Asp score 6-8)
.009
1.000
.370
.543
Abbreviations: ETT, esophageal transit time; PCR, pharyngeal constriction ratio; Pen-Asp, penetration-aspiration; PESmax, pharyngoesophageal segment maxi-
mum opening; PTT, pharyngeal transit time; SD, standard deviation.
a
Bolding indicates that the
P
values have reached significance.
Miles et al
116