Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES
Mariam Jaghbeer, Anna‐Liisa Sutt, Liza Bergström
Abstract
Abstract This study investigated the reliability and validity (sensitivity and specificity) of cervical auscultation (CA) using both swallow and pre-post swallow-respiratory sounds, as compared with Flexible Endoscopic Evaluation of Swallowing (FEES). With 103 swallow-respiratory sequences from 23 heterogenic patients, these swallows sounds were rated by eight CA-trained Speech-Language Pathologists (SLPs) to investigate: (1) if the swallow was safe (primary outcome); (2) patient dysphagia status; (3) the influence of liquid viscosity on CA accuracy (secondary outcomes). Primary outcome data showed high CA sensitivity (85.4%), and specificity (80.3%) with all consistencies for the safe measurement, with CA predictive values of $$>$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>></mml:mo> </mml:math> 90% to accurately detect unsafe swallows. Intra-rater reliability was good (Kappa $$=$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>=</mml:mo> </mml:math> 0.65), inter rater reliability moderate (Kappa $$=$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>=</mml:mo> </mml:math> 0.58). Secondary outcome measures showed high sensitivity (80.1%) to identify if a patient was dysphagic, low specificity (22.9%), and moderate correlation (r s $$=$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>=</mml:mo> </mml:math> 0.62) with FEES. A difference across bolus viscosities identified that CA sensitivities (90.1%) and specificities ( $$>$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>></mml:mo> </mml:math> 84.7%) for thin liquids were greater than for thick liquids (71.0–77.4% sensitivities, 74.0–81.3% specificities). Results demonstrate high validity and moderate-good reliability of CA-trained SLPs to determine swallow safety when compared with FEES. Data support the use of CA as an adjunct to the clinical swallow examination. CA should include pre-post respiratory sounds and requires specific training. Clinical implications : The authors advocate for holistic dysphagia management including instrumental assessment and ongoing CSE/review $$+$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mo>+</mml:mo> </mml:math> CA. Adding CA to the CSE/review does not replace instrumental assessment, nor should CA be used as a stand-alone tool.