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Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

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

CORRESPONDENCE: K. Weir, Speech Pathology Dept Level 4 Coles Health Services Building, Royal Children's Hospital, Herston Rd, Herston, QLD 4029, Australia. Fax: 61 736361978. E-mail: Kelly_Weir{at}health.qld.gov.au

Keywords: Aspiration, clinical signs, dysphagia, modified barium swallow, oropharyngeal aspiration, videofluoroscopy

Received: June 15, 2008
Accepted October 12, 2008

The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA.

In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction.

In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87–27.62), wet breathing (OR 3.35, 95% CI 1.09–10.28) and cough (OR 3.30, 95% CI 1.17–9.27) 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 OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22–10.55). Differences were found for age.

Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.