HSC Section 6 Nov2016 Green Book

Miles et al

Table 2. Comparison of Referral Sources.

Frequency (% within Referral Type)

x 2

P Value a

Characteristic

ORL

SLP

Number of files

59

52

neurological etiology neurological etiology

Age ( . 65 y) Sex (male)

37 (63) 20 (33)

47 (90) 31 (60) 32 (62) 10 (19)

11.50

.001 .008 .000

7.36

Etiology—neurological

4 (7)

44.01

Dysphagia of unknown cause ORL (H&N cancer, GERD) Other (unwell elderly, pneumonia) Frequency of oral abnormalities Frequency of pharyngeal abnormalities Frequency of esophageal abnormalities Frequency of PCR outside 2 SD of norm Frequency of PESmax outside 2 SD of norm

27 (46) 24 (41)

4 (8)

4 (6)

6 (11)

11 (19) 10 (17) 43 (73)

27 (52) 40 (77) 33 (63)

13.60 40.16

.000 .000 .312 .006 .625 .139 .099 .003

1.14 8.26

1 (2)

9 (17) 8 (36)

12 (20)

.340

PTT outside 2 SD of norm

7 (12)

12 (23) 19 (37) 12 (23)

2.33 2.83 9.72

ETT . 15 seconds

13 (22)

Aspiration event occurred (Pen-Asp score 6-8)

2 (3)

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 Transit Time . 15 Seconds

Esophageal Abnormalities

x 2

x 2

P Value a

P Value

Characteristic

Age ( . 65 y) Sex (male)

.000 .006

1.000 1.000

3.42

.087 .675 .481 .030 .504 .466 .266 .000 .543

.298

Etiology

1.645

.678 .826

2.54 4.96

Frequency of oral abnormalities

.089 .001 .617

Frequency of pharyngeal abnormalities Frequency of PCR outside 2 SD of norm Frequency of PESmax outside 2 SD of norm

1.000

.446 .723 .029

.474 .054

4.41

1.00

PTT outside 2 SD of norm

.047

1.000

1.89

ETT . 15 seconds

19.15

.000

20.71

Aspiration event occurred (Pen-Asp score 6-8)

.009

1.000

.370

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.

Discussion

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

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

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