Index > Vol. 41/2009 > Iss. 8/July > pp. 639-645 > Abstract
Original report

Acoustic analysis of swallowing sounds: A new technique for assessing dysphagia

doi: 10.2340/16501977-0384

Abstract:

Objective: To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration.
Design: Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endo­scopy of swallowing as criterion standard.
Subjects: Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases.
Methods: Mean duration of the swallowing sounds and post-swallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia.
Results: The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24–0.94); specificity 1.00 (95% confidence interval 0.56–1.00)).
Conclusion: The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures.

Authors:

Andrea Santamato, Francesco Panza, Vincenzo Solfrizzi, Anna Russo, Vincenza Frisardi, Marisa Megna, Maurizio Ranieri, Pietro Fiore

Key words:

auscultation, dysphagia, swallowing disorders, deglutition disorders, respiratory aspiration, stroke.

References

  1. Smithard DG, O-Neill PA, England RE, Park CL, Wyatt R, Martin DF, et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12: 188-193. Link to article
  2. Katzan IL, Cebul RD, Husak SH, Dawson NV, Baker DW. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology 2003; 60: 620-625.
  3. Palmer JB, Rudin NJ, Lara G, Crompton AW. Coordination of mastication and swallowing. Dysphagia 1992; 7: 187-200. Link to article
  4. Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, et al. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke 2005; 36: e100-e143. Link to article
  5. Ramsey DJ, Smithard DG, Kalra L. Early assessment of dysphagia and aspiration risk in acute stroke patients. Stroke 2003; 34: 1252-1257. Link to article
  6. Takahashi K, Groher ME, Michi K. Methodology for detecting swallowing sounds. Dysphagia 1994; 9: 54-62.
  7. Mackowiak RC, Brenman HS, Fridman MHF. Acoustic profile of deglutition. Proc Soc Exp Biol Med 1967; 125: 1149-1152.
  8. Cichero JA, Murdoch BE. Acoustic signature of the normal swallow: characterization by age, gender, and bolus volume. Ann Otol Rhinol Laryngol 2002; 111: 622-623.
  9. Kley C, Biniek R. Dysphagie. Sind schluck ger��usche diagnostich nutzbar? Nervenarzt 2005; 76: 1495-1505. Link to article
  10. Youmans SR, Stierwalt JA. An acoustic profile of normal swallowing. Dysphagia 2005; 20: 195-209. Link to article
  11. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442.
  12. The ALS Ciliary Neurotrophic Factor Treatment Study (ACTS) Phase 1-11 Study Group. The amyotrophic lateral sclerosis functional rating scale: assessment of activities of daily living in patients with amyotrophic lateral sclerosis. Arch Neurol 1996; 53: 141-147.
  13. Oguz H, Demirci M, Safak MA, Arslan N, Islam A, Kargin S. Effects of unilateral vocal cord paralysis on objective voice measures obtained by Praat. Eur Arch Otorhinolaryngol 2007; 264: 257-261. Link to article
  14. Perlman AL, Ettema SL, Barkmeier J. Respiratory and acoustic signals associated with bolus passage during swallowing. Dysphagia 2000; 15: 89-94.
  15. Moussavi ZK, Leopando MT, Pasterkamp H, Rempel G. Computerised acoustical respiratory phase detection without airflow measurement. Med Biol Eng Comput 2000; 38: 198-203. Link to article
  16. Altman DG, Bland JM. Diagnostic tests 2: Predictive values. BMJ 1994; 309: 102.
  17. Smithard DG. Swallowing and stroke. Cerebrovasc Dis 2002; 14: 1-8.
  18. Hamlet S, Penney DG, Formolo J. Stethoscope acoustics and cervical auscultation of swallowing. Dysphagia 1994; 9: 63-68.
  19. Hamlet SL, Nelson RJ, Patterson RL. Interpreting the sounds of swallowing: fluid flow through the cricopharyngeus. Ann Otol Rhinol Laryngol 1990; 99749-99752.
  20. Cichero JA, Murdoch BE. The physiologic cause of swallowing sounds: answers from heart sounds and vocal tract acoustics. Dysphagia 1998; 13: 39-52. Link to article
  21. Nilsson H, Ekberg O, Olsson R, Hindfelt B. Quantitative aspects of swallowing in an elderly nondisphagic population. Dysphagia 1996; 11: 180-184. Link to article
  22. Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 1992; 103: 823-829.
  23. Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, et al. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol 1990; 258: G675-G681.
  24. Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, et al. Effects of bolus volume, viscosity, and repeated swallows in non stroke subjects and stroke patients. Arch Phys Med Rehabil 1993; 74: 1066-1070. Link to article
  25. Cichero JA, Murdoch BE. Detection of swallowing sounds: method��ology revisited. Dysphagia 2002; 17: 40-49. Link to article