[Dysphagia] Silent aspiration

[nprw at xmission.com (Lynne)]

Here is an abstract from pubmed.com.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15667057&itool=iconabstr&query_hl=2 
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15667057&itool=iconabstr&query_hl=2>

Dysphagia. 2004 Fall;19(4):231-40. Related Articles, Links 

Reliability and validity of cervical auscultation: a controlled 
comparison using videofluoroscopy.

Leslie P, Drinnan MJ, Finn P, Ford GA, Wilson JA.

School of Surgical and Reproductive Sciences, The Medical School, 
University of Newcastle, Newcastle-upon-Tyne, United Kingdom. 
Paula.Leslie@newcastle.ac.uk

Cervical auscultation is experiencing a renaissance as an adjunct to the 
clinical swallowing assessment. It is a controversial technique with a 
small evidence base. We have aimed to establish whether cervical 
auscultation interpretation is based on the actual sounds heard or, in 
practice, influenced by information gleaned from other aspects of the 
clinical assessment, medical notes, or previous knowledge. We sought to 
determine (a) rater reliability and its impact on the clinical value of 
cervical auscultation and (b) how judgments compare with the "gold 
standard": videofluoroscopy. Swallow sounds were computer recorded via a 
Littmann stethoscope. Sounds were sampled from 10 healthy control 
swallows with no aspiration/penetration and 10 patient swallows with 
aspiration/penetration, all recorded during simultaneous 
videofluoroscopy. The system generated sound quality similar to "live" 
bedside listening, a feature rarely seen in cervical auscultation 
studies. The 20 sound clips were classified as "normal" or "abnormal" by 
19 volunteer speech-language pathologists with experience in cervical 
auscultation. After at least four weeks, 11 of these judges rated the 
sounds rerandomized on a new CD. Intrarater reliability kappa ranged 
from -0.12 to 0.71. Individual reliability did not correlate with years 
of experience, practice pattern, or frequency of use. Interrater 
reliability kappa = 0.17. Comparison with radiologically defined 
aspiration/penetration yielded 66% specificity, 62% sensitivity, and 
majority consensus gave 90% specificity, 80% sensitivity. There was a 
significant relationship between individual reliability and true 
positive rate (r(s) = 0.623, p = 0.040). The reliability of individual 
judges varied widely and thus, inevitably, agreement between judges was 
poor. Validity is dependent upon reliability: Improving the poor raters 
would improve the overall accuracy of this technique in predicting 
abnormality in swallowing. The group consensus correctly identified 17 
of the 20 clips so we may speculate that the swallow sound contains 
audible cues that should in principle permit reliable classification.

Lynne

Paula leslie wrote:

>I am curious about how exactly CA allows one to detect "silent aspiration" 
>when, to my knowledge, there is no evidence that shows aspiration (silent or 
>otherwise) linked to any sound made before, during or after swallowing.  We 
>need videofluoroscopy or laryngoscopy images ie direct visualisation done on 
>the same swallow not just the same patient at a different time.  Anything else 
>is just presumption of a link.  People do talk of wet breath sounds but again 
>there is no evidence of what exactly this is.
>
>Features such as coughing, wet voice, stridor etc do not need CA to be 
>detected.
>
>People may have such data from simultaneous swallow studies, ie CA AND VF/LSE 
>done at the same time.  If so it would be very useful to get them into the 
>public domain to increase the evidence base on this topic.
>
>Paula
>
>
>
>
>
>  
>
>>===== Original Message From Kimberley ODonnell 
>>    
>>
><OdonneK@doh.health.nsw.gov.au> =====
>  
>
>>I agree that cervical auscultation is extremely useful in detecting
>>silent aspiration in many but not all people.   Wouldn't be without it.
>>Kim
>>
>>Kimberley O'Donnell
>>Speech Pathologist - BAppSc MSPAA CPSP
>>Royal Rehab. Centre Sydney
>>ph:(02) 9808 9210 or (02) 9807 1144 - pager 48
>>59 Charles Street   RYDE   NSW 2112
>>
>>    
>>
>>>>Pat Buen <patbuen@telus.net> 10/11/2005 2:56:15 pm >>>
>>>>        
>>>>
>>As Debbie states, however my last bedside test (b/4 VFSS if needed)
>>includes
>>cervical auscultation and a good assessment of  lung status.
>>Pat
>>----- Original Message -----
>>From: <LCDM11@aol.com>
>>To: <tervomm@yahoo.com>; <dysphagia@b9.com>
>>Sent: Wednesday, November 09, 2005 7:38 PM
>>Subject: Re: [Dysphagia] Silent aspiration
>>
>>
>>    
>>
>>>It's SILENT aspiration. It can't be determined at bedside. You may
>>>      
>>>
>>have
>>    
>>
>>>reason to suspect it, but it CAN NOT be determined by a clinical
>>>      
>>>
>>evaluation.
>>    
>>
>>>Debbie
>>>_______________________________________________
>>>Dysphagia mailing list
>>>Dysphagia@b9.com
>>>http://lists.b9.com/mailman/listinfo/dysphagia
>>>      
>>>
>
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