Aerodigestive Innovations Research Lab, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York City, NY.
Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY.
J Speech Lang Hear Res. 2023 Jul 12;66(7):2260-2277. doi: 10.1044/2023_JSLHR-23-00132. Epub 2023 Jun 21.
The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES).
FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows.
Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g saltine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow.
The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing outcomes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample ( = 39), with most people below the age of 60 years ( = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. Supplemental Material and Open Science Form: https://doi.org/10.23641/asha.23504325.
本研究旨在为可视吞咽评估安全与效率（VASES）建立初步的参考值，这是一种用于评估经口内镜吞咽评估（FEES）吞咽安全性和效率的标准化评分方法。
使用 15 种不同大小、稠度、对比剂和吞咽指导的吞咽试验，在非吞咽障碍的社区居住成年人中完成 FEES。使用 VASES 对 FEES 进行盲法分析。主要结局指标包括吞咽起始时的食团位置、渗透-误吸量表（PAS）评分以及 6 个解剖标志的基于百分比的残留评分。次要结局指标包括吮吸量、咀嚼量和吞咽次数。
39 名健康成年人完成了研究，共分析了 584 次吞咽。在 41.8%的试验中，食团在吞咽起始时位于咽部。最常见的 PAS 评分为 1 分，占试验的 75.3%，其次是 PAS 3 分，占试验的 18.8%。当存在残留（>0%）时，所有解剖标志的残留量都相对较小，残留评分中位数分别为咽（口咽）2.0%、喉（下咽）1.5%、会厌（会厌）3.0%、声门（喉前庭）3.0%和声带（声带）3.5%。观察到 5 次误吸事件，其特征为声门下残留评分为 1%、3%、10%、24%和 90%。自选自用容量杯饮水的平均吮吸量为 19.8ml，3.0g 椒盐饼干的平均咀嚼量为 1.33g。此外，本研究方案中的 78%试验（90ml 试验除外）可在单次吞咽中完成。
本研究结果为 VASES 提供了初步的规范，可作为评估 FEES 期间功能性吞咽结果的参考。虽然这是为 FEES 和 VASES 建立规范的重要第一步，但临床医生和研究人员应该注意到，本研究的规范参考值来自相对较小的研究样本（n=39），大多数人年龄在 60 岁以下（n=30）。未来的研究应通过纳入更多跨越年龄范围的人群，并具有更大的种族、民族和性别多样性来扩展这些规范。补充材料和开放科学表格：https://doi.org/10.23641/asha.23504325。
