AJR:178, February 2002 393 Videofluoroscopic Assessment of Patients with Dysphagia: Phar yngeal Retention Is a Predictive Factor for Aspiration OBJECTIVE. This study evaluated the clinical significance of pharyngeal retention to predict aspiration in patients with dysphagia. MATERIALS AND METHODS. At videofluoroscopy, pharyngeal retention was found in 108 (28%; 73 males, 35 females; mean age, 60 years) of 386 patients with a suspected de- glutition disorder. Swallowing function was assessed videofluoroscopically. The amount of residual contrast material in the valleculae or piriform sinuses was graded as mild, moderate, or severe. The frequency, type, and grade of aspiration were assessed. RESU LT S. Pharyngeal retention was caused by pharyngeal weakness or paresis in 103 (95%) of 108 patients. In 70 patients (65%) with pharyngeal retention, postdeglutitive over- flow aspiration was found. Aspiration was more often found in patients who had additional functional abnormalities such as incomplete laryngeal closure or impaired epiglottic tilting (p < 0.05). Postdeglutitive aspiration was diagnosed in 25% patients with mild, in 29% with mod- erate, and in 89% with severe pharyngeal retention ( p < 0.05). CONCLUSION. Postdeglutitive overflow aspiration is a frequent finding in patients with pharyngeal retention, and the risk of aspiration increases markedly with the amount of resi- due. Functional abnormalities other than pharyngeal weakness, such as impaired laryngeal closure, may contribute to aspiration. haryngeal residue in the valleculae and in the piriform sinuses after swallowing is seen in up to 20% of elderly asymptomatic individuals [1]. It is not clear whether the occurrence of pharyngeal re- tention in these patients is a normal finding caused by aging or whether it should be consid- ered abnormal [1, 2]. Nevertheless, an increased pharyngeal residual volume represents the car- dinal feature of impaired or incomplete pharyn- geal bolus transportation [3, 4]. A potentially severe complication of pharyngeal retention is overflow bolus aspiration into the airways after swallowing [3, 4]. Aspiration is the most serious abnormality during videofluoroscopic examina- tion; it can lead to pulmonary complications such as aspiration pneumonia [5, 6]. Videofluoroscopic examination of swallow- ing is a valuable and reliable tool for evaluat- ing the pharyngeal stage of deglutition [7]. To date, no studies examining the clinical rele- vance of pharyngeal retention in symptomatic patients have been performed. The aim of our study was to evaluate the functional abnormal- ities associated with pharyngeal retention and the clinical significance of pharyngeal reten- tion in patients with dysphagia. Materials and Methods Patients From October 1998 to July 2000, 386 consecu- tive patients (199 males, 187 females; mean age, 51 years) with symptoms indicative of a deglutition dis- order were referred to our department for a videoflu- oroscopic study of the pharynx and esophagus. Videofluoroscopic and clinical findings and demo- graphic data for all patients were prospectively en- tered into a computer database (Excel 97; Microsoft, Redmond, WA). Through retrospective review of the computer database, we identified 108 patients (28%) with pharyngeal residue seen at videofluoroscopy. The patients were 73 males and 35 females with an age range of 14–88 years. The presenting symptom was dysphagia in 42 patients (for solids in 27, for solids and liquids in 14, for liquids only in one), sus- pected aspiration in 58, globus sensation in five, noncardiac chest pain in two, and nasal regurgitation in one patient. Duration of symptoms ranged from 1 week to 20 years. Underlying diseases or conditions that are known to cause deglutition disorders were found in 102 patients (94%). Thirteen patients had a Edith Eisenhuber 1 Wolfgang Schima Ewald Schober Peter Pokieser Alfred Stadler Martina Scharitzer Elisabeth Oschatz Received June 4, 2001; accepted after revision September 28, 2001. Presented at the annual meeting of the American Roentgen Ray Society, Seattle, April–May 2001. 1 All authors: Department of Radiology and Ludwig Boltzmann-Institute for Clinical and Experimental Radiologic Research, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address correspondence to E. Eisenhuber. AJR 2002;178:393–398 0361–803X/02/1782–393 © American Roentgen Ray Society P Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved