Validation of the Munich Swallowing Score (MUCSS) in patients with neurogenic dysphagia: A preliminary study.

BACKGROUND: The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE: The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS: The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS: Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS: These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.

[Swallowing examination for ENT specialists]. / Dysphagiediagnostik durch den HNO-Arzt.

Dysphagias, together with the diseases resulting therefrom, severely reduce patients' quality of life and substantially increase the costs of public health, making efficient therapy a prime concern. Among pathophysiologically oriented diagnostic procedures, the endoscopic examination of swallowing has emerged within the past 20 years as an indispensable standard examination with high sensitivity and specificity. Thus, every ears, nose, and throat (ENT) physician and phoniatric specialist should be familiar with this procedure, in order to ensure widest possible access to it, not only in hospitals but also in outpatient settings and in healthcare establishments. In this article, the preconditions, execution, and evaluation of the endoscopic examination are described and its relevance for immediate or long-term therapeutic treatment is discussed.

[Hypersalivation - inauguration of the S2k Guideline (AWMF) in short form]. / Hypersalivation - Ersterstellung der S2k-Leitlinie (AWMF) in gekürzter Darstellung.

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.

Values and limitations of pharyngolaryngoscopy (transnasal, transoral) in patients with dysphagia.

During the last decade, videoendoscopic evaluation of structures and sensorimotor functions of the pharynx and larynx has been established as a valuable tool in the assessment of dysphagia. This method is feasible at a very early stage and in critically ill patients, is not invasive and frequently repeatable. Several authors described the high sensitivity and specificity of this method in detecting the presence of the most important symptoms of swallowing dysfunction: retention, penetration and aspiration. In our study of 39 patients with neurogenic dysphagia, we found high agreement between the results of videoendoscopic and videofluoroscopic examination regarding the registration of the most critical symptom, i.e. aspiration. Moreover, we observed patients who aspirated only their saliva and whose endoscopically verified aspiration problem remained undetected by radiographic examination, probably due to the lower sensory input of saliva as compared to a contrast medium. Since the detection of aspiration of saliva is of high clinical relevance for pulmonary function, the endoscopic examination turned out to be superior, in this particular respect, to the radiographic examination. However, the method fails to provide sufficient information regarding the cause of the observed symptoms or the amount of aspirated material. Six patients in our study exhibited, in addition to the neurological signs, structural changes (diverticula, pouches) or unexpected functional esophageal disturbances (persistent opening of the upper esophageal sphincter, retrograde peristalsis) which could only be detected by radiographic examination. The two methods should therefore be considered complementary.