Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-020-06429-2 LARYNGOLOGY Predictive factors of severity and persistence of oropharyngeal dysphagia in sub‑acute stroke Alessandro De Stefano 1  · Francesco Dispenza 2  · Gautham Kulamarva 3  · Giuseppina Lamarca 1  · Antonio Faita 4  · Antonio Merico 4  · Giuseppe Sardanelli 4  · Salvatore Gabellone 4  · Antonio Antonaci 5 Received: 15 May 2020 / Accepted: 7 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose This study aims to understand the factors contributing to the severity of oropharyngeal dysphagia and its persistence in the sub-acute phase of stroke. Methods We retrospectively collected the data of all the patients sufering from a stroke in the last year. The severity of stroke was reported according to the NIHSS score. All the patients were evaluated with the Dysphagia Risk Score and with a FEES. We classifed the Dysphagia Risk Score and FEES results using the PAS score and ASHA-NOMS levels. The data were analysed statistically with ANOVA test, Student’s t test and Pearson’s correlation coefcient. Results A series of 54 patients were evaluated. The ANOVA test did not fnd any diference in the mean score of Dysphagia Risk Score, PAS and ASHA-NOMS when compared with the brain area of stroke. An NIHSS at hospital admission (stroke unit) of more than 12 was predictive of ASHA-NOMS score 1–4 after 60 days (p < 0.05). A PAS score between 6 and 8 at frst FEES evaluation was predictive of poor (1–4) ASHA-NOMS score after 60 days (p < 0.01). A moderate positive linear correlation was found between NIHSS score and both PAS (r 0.65) and Dysphagia Risk Score (r 0.50); a moderate negative linear correlation was recorded between NIHSS and ASHA-NOMS (r − 0.66) scores. Conclusion In the sub-acute phase of stroke, the predictive factors of persistent dysphagia are not linked to the damaged neuroanatomical region and others factors such as NIHSS value and high PAS score seem more useful. Keywords Dysphagia · FEES · Stroke · Aspiration · Nasogastric tube · Predictor factors Introduction Stroke or cerebrovascular accidents, as we all know, is a result of a disturbance in the vascular supply of the brain, causing loss or impairment of the respective functions of the region of the brain afected [1]. It may be ischemic or hemorrhagic depending on whether there is an occlusion of the vasculature or its rupture [1]. There can be two phases of stroke. The acute phase which last for about 2 weeks after the onset of lesion and the sub-acute phase last up from 2 weeks to 6 months after onset [2] Cerebrovascular accidents are the second leading cause of preventable death worldwide and the fourth leading cause of lost productivity, as measured by disability-adjusted life years. According to estimates by the World Health Organiza- tion, stroke accounted for 5.7 million deaths and 16 million frst-time events in 2005 and these numbers may reach 7.8 million and 23 million by 2030, respectively [2]. Oropharyngeal dysphagia (OD) afects more than 50% of the patients sufering from a stroke. Fortunately, the major- ity of them recover swallowing function within a few weeks (during the sub-acute phase of stroke) and only 11–13% remain dysphagic after 6 months or more [3]. Unfortunately, OD occurring as a major sequelae of stroke is also the principal cause of death in these patients, * Alessandro De Stefano dr.adestefano@gmail.com 1 U.O. Foniatria, Dipartimento di Riabilitazione, ASL Lecce, Piazza Bottazzi, 73100 Lecce, Italy 2 U.O. Otorinolaringoiatria, Policlinico Giaccone, Università degli Studi di Palermo, Palermo, Italia 3 ENT Department, Maithri Speciality Clinics, Mangaluru, India 4 U.O. Medicina Fisica e Riabilitazione Neuromotoria, Ospedale “Santa Caterina Novella”, ASL Lecce, Galatina (Lecce), Italia 5 Dipartimento di Riabilitazione, ASL Lecce, Lecce, Italia