Simultaneous Bed Side Evaluation of Dysphagia and Dysphonia in Patients Under Acute Treatment for Central Nervous System Disorders.

Abstract

Objective: Hoarseness is often observed in patients with acute central nervous system (CNS) impairment. However, the vocal function is not routinely assessed. The purpose of this prospective study was to reveal the severity of dysphagia and dysphonia simultaneously during a bed side swallowing assessment in patients with CNS disorders.

Study design: Prospective observational cohort study.

Methods: The bed side evaluation of swallowing and vocal function was performed in 24 patients (aged 22-96 years; 14 male, 10 female) who were admitted to the Center for Neurology and Medical Science of out institute. They were suspected to have aspiration by a routine screening examination and required a bed side swallowing endoscopic assessment. The swallowing functions were evaluated by videoendoscopic swallowing test and Food Intake Level Scale (FILS). Vocal function was evaluated by bed side stroboscopic examinations with the measurement of vocal fold vibratory amplitude (VFVA) and Bowing Index (BI). Grade Roughness Breathiness Asthenia and Strain scale, aerodynamic and acoustic analyses were also completed. In addition, grip strength, tongue pressure measurements, geriatric nutritional risk index (GNRI), and the respiratory function tests were evaluated.

Results: Swallowing and vocal function were impaired in all patients. An overall FILS average was level 4-6 that required alternative nutrition. Vocal fold atrophy was observed in 19 patients with reduced values in both VFVA and BI. Inspiratory function and muscle strength were decreased compared to the average of the healthy elderly, and the overall average of nutrition fell into the category of moderate nutritional impairment.

Conclusions: The current study revealed that both swallowing and vocal function were impaired in the patients under acute treatment of CNS disorders. It was suggested that several factors can affect swallowing and vocal disorder in CNS disorder patients, including vocal fold atrophy, poor respiratory function, reduced muscle strength, and poor nutritional status, which should be kept in mind during the treatment or rehabilitation for CNS disorders.