# Pharyngeal phase of swallowing in post-stroke dysphagia: videoendoscopy and speech-language-hearing assessment

## TL;DR

This study compares swallowing difficulties in stroke patients and non-stroke patients using videoendoscopy and clinical assessments across different food consistencies.

## Contribution

The study identifies significant differences in pharyngeal swallowing signs between stroke and non-stroke dysphagic individuals across various food consistencies.

## Key findings

- Stroke patients showed significant differences in pharyngeal residue, laryngeal penetration, and aspiration across all food consistencies.
- Multiple swallowing was associated with thin liquid, slightly thickened liquid, and solid consistencies (p=0.026).
- Differences in swallowing patterns were observed in thin liquid, extremely thickened liquid, and solid consistencies for stroke patients.

## Abstract

To investigate the outcomes of fiberoptic endoscopic evaluation of pharyngeal swallowing phase and clinical evaluation of swallowing among dysphagic individuals with and without chronic stroke in different food consistencies.

This is a cross-sectional and retrospective study based on data collection from medical records. 134 swallowing video endoscopy exams of dysphagic patients were analyzed, in which they were divided into two groups according to the diagnosis of stroke, in which data were collected regarding mobility and strength of the tongue, phonation and cough efficiency, and the pharyngeal signs of dysphagia with four food consistencies from the International Dysphagia Diet Standardization Initiative (IDDSI), for comparison between groups. To analyze and classify the severity of pharyngeal residues, the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) was used by two independent professionals.

There was a significant difference in the presence of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration in all consistencies evaluated (level 0, 2, 4 and 7) (p= <0.001), in addition to the association with multiple swallowing in thin liquid, slightly thickened liquid and solid (level 0, 2 and 7) (p= 0.026).

Dysphagic individuals diagnosed with stroke showed differences in videoendoscope signs of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration, regardless of the food consistency assessed, compared to dysphagic individuals without the diagnosis. Just as there was a difference in the finding of multiple swallowing only in the consistencies of thin liquid, extremely thickened liquid and solid.

Investigar os achados videoendoscópios da fase faríngea da deglutição e da avaliação clínica da deglutição, entre indivíduos disfágicos com e sem AVE crônico em diferentes consistências alimentares.

Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram analisados 134 exames da videoendoscopia da deglutição de pacientes disfágicos, em que foram divididos em dois grupos de acordo com o diagnóstico de AVE, na qual, foram coletados dados com relação à mobilidade e força de língua, fonação e eficiência da tosse, e os sinais faríngeos de disfagia com quatro consistências alimentares do International Dysphagia Diet Standartisation Initiative (IDDSI), para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) por dois profissionais independentes.

Houve diferença significativa com a presença de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal em todas as consistências avaliadas (nível 0, 2, 4 e 7) (p= <0,001), além da associação com deglutições múltiplas em líquido ralo, líquido levemente espessado e sólido (nível 0, 2 e 7) (p= 0,026).

Os indivíduos disfágicos com diagnóstico de acidente vascular encefálico apresentaram diferença nos sinais videoendoscópios de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal independentemente da consistência alimentar avaliada, em comparação aos indivíduos disfágicos sem o diagnóstico. Assim como houve diferença no achado da deglutição múltipla apenas nas consistências de líquido ralo, líquido extremamente espessado e sólido.