Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

¹ Speech Pathology Dept, Royal Children's Hospital, Brisbane, Queensland; and Dept of Paediatrics and Child Health, University of Queensland, Queensland
² SpeechNet Speech Pathology Services, Queensland
³ Speech Pathology Dept, Royal Children's Hospital, Brisbane, Queensland
⁴ Dept of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland
⁵ Dept of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland; and Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia

	Abstract

The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. A retrospective study was undertaken to i) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR), (ii) determine the sensitivity and specificity of clinical markers associated with OPA, and (iii) determine the influence of age and neurological impairment on clinical markers of OPA.

Eleven clinical markers of dysphagia were compared to the Videofluoroscopic Swallow Study (VFSS) results (OPA, ILP and PSR) in 150 children on thin fluid and puree consistencies. Chi square and logistic regression were used to analyse the association between clinical markers and VFSS identified swallowing dysfunction.

Wet voice (OR 8.90, 95%CI 2.87–27.62, p<0.001), wet breathing (OR 3.35, 95%CI 1.09–10.28, p=0.035), and cough (OR 3.30, 95%CI 1.17–9.27, p=0.024) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67, specificity 0.92), wet breathing (sensitivity 0.33; specificity 0.83) and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with puree OPA, ILP or PSR on puree. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95%CI 1.22–10.55, p=0.020). Differences were found for age.

Wet voice, wet breathing and cough were good clinical markers of thin fluid OPA but not for puree OPA. Age and neurological status influences the significance of these clinical markers.