Relationship between post-stroke dysphagia and pharyngeal sensory impairment

Bendix Labeit; Anne Jung; Sigrid Ahring; Stephan Oelenberg; Paul Muhle; Malte Roderigo; Fiona Wenninger; Jonas von Itter; Inga Claus; Tobias Warnecke; Rainer Dziewas; Sonja Suntrup-Krueger

doi:10.1186/s42466-023-00233-z

Relationship between post-stroke dysphagia and pharyngeal sensory impairment

Neurol Res Pract. 2023 Feb 16;5(1):7. doi: 10.1186/s42466-023-00233-z.

Authors

Bendix Labeit^#^{1

2}, Anne Jung^#³, Sigrid Ahring³, Stephan Oelenberg³, Paul Muhle^{3

4}, Malte Roderigo³, Fiona Wenninger³, Jonas von Itter³, Inga Claus³, Tobias Warnecke⁵, Rainer Dziewas⁵, Sonja Suntrup-Krueger³

Affiliations

¹ Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany. Bendixruven.Labeit@ukmuenster.de.
² Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany. Bendixruven.Labeit@ukmuenster.de.
³ Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany.
⁴ Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany.
⁵ Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the WWU, Muenster, Germany.

^# Contributed equally.

Abstract

Background: Post-stroke dysphagia (PSD) is common and can lead to serious complications. Pharyngeal sensory impairment is assumed to contribute to PSD. The aim of this study was to investigate the relationship between PSD and pharyngeal hypesthesia and to compare different assessment methods for pharyngeal sensation.

Methods: In this prospective observational study, fifty-seven stroke patients were examined in the acute stage of the disease using Flexible Endoscopic Evaluation of Swallowing (FEES). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and impaired secretion management according to the Murray-Secretion Scale were determined, as well as premature bolus spillage, pharyngeal residue and delayed or absent swallowing reflex. A multimodal sensory assessment was performed, including touch-technique and a previously established FEES-based swallowing provocation test with different volumes of liquid to determine the latency of swallowing response (FEES-LSR-Test). Predictors of FEDSS, Murray-Secretion Scale, premature bolus spillage, pharyngeal residue, and delayed or absent swallowing reflex were examined with ordinal logistic regression analyses.

Results: Sensory impairment using the touch-technique and the FEES-LSR-Test were independent predictors of higher FEDSS, Murray-Secretion Scale, and delayed or absent swallowing reflex. Decreased sensitivity according to the touch-technique correlated with the FEES-LSR-Test at 0.3 ml and 0.4 ml, but not at 0.2 ml and 0.5 ml trigger volumes.

Conclusions: Pharyngeal hypesthesia is a crucial factor in the development of PSD, leading to impaired secretion management and delayed or absent swallowing reflex. It can be investigated using both the touch-technique and the FEES-LSR-Test. In the latter procedure, trigger volumes of 0.4 ml are particularly suitable.

Keywords: Aspiration; Oropharyngeal dysphagia; Pneumonia; Post stroke dysphagia; Stroke.