Author(s)
Karuna Dewan, MD
John Clarke, MD
Heather Starmer, MA
Affiliation(s)
Stanford University Medical School;
Abstract:
Dysphagia encompasses a complex compilation of symptoms which often differ from objective swallowing evaluation findings. The purpose of this investigation was to compare the results of subjective dysphagia measures to objective measures of swallowing in patients evaluated in a multidisciplinary dysphagia clinic. The study cohort included all patients evaluated in the multidisciplinary dysphagia clinic over 24 months. The multidisciplinary team includes laryngologist, gastroenterologist, and speech-language pathologist. Evaluation included a modified barium swallow (MBS), fiberoptic endoscopic evaluation of swallowing (FEES) and transnasal endoscopy (TNE). Data collected included diet (FOIS), Eating Assessment Tool (EAT-10) score, Reflux symptom index (RSI) score, and MBS exam findings.Analysis included 75 patients. The average EAT-10 score was 17.7, RSI was 22.3, and FIOS was 5.9. MBS revealed impairments in oral phase in 40% of the cohort, pharyngeal in 59% and esophageal in 49%. Abnormalities were noted in one phase for 32%, in 2 phases in 32%, and three phases in 18%. Patients with abnormal pharyngeal findings on MBS had significantly higher EAT-10 scores (p=0.04) than patients with normal pharyngeal phase. Patients with abnormal oral findings on MBSS were noted to have significantly lower FIOS scores (p=0.03) than patients with normal oral phase. No significant relationships existed between the number of abnormalities noted on MBSS and the severity of the EAT-10 or RSI scores.Our data demonstrate a relationship between patient reported symptoms and objective MBS findings in patients undergoing multidisciplinary swallowing assessment suggesting such surveys are helpful screening tools but inadequate.