Measurement of Pharyngeal Residue From Lateral View Videofluoroscopic Images.
Catriona M Steele, Melanie Peladeau-Pigeon, Ahmed Nagy and 1 others
PMID 32379520WHAT IT FOUND
Visual ratings of pharyngeal residue on videofluoroscopy agreed well but were less exact.
Pixel measures using a neck length reference were steadier across raters and recommended for treatment comparisons.
Key findings
01Visual Eisenhuber ratings did not match pixel percent-filled space classifications for 20.6% of vallecular residue ratings and 14.2% of pyriform sinus residue ratings.
02The pixel measure of pyriform sinus housing area, used in percent-filled space and NRRS calculations, showed agreement of .635 between raters, which the study rated as moderate.
03Raters agreed strongly on residue measured relative to C2-4 neck length, including a combined vallecular and pyriform sinus score.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The paper reports 3,545 boluses, not patients, so the findings cannot be tied to individual patients. The sample was mixed: adults referred for suspected dysphagia with no history of oncological, structural, or congenital dysphagia, but not grouped by diagnosis. Only the first swallow of each bolus was analyzed, so patterns across later swallows or repeated boluses were not tested. All measures came from 2D lateral views, so left-right asymmetries in residue could not be captured. Rater agreement for spatial housing area was weaker, and that area is used in percent-filled space and NRRS measures. The paper states that the field lacks a clear definition of how much residue should be considered a finding of concern. The paper did not test whether any residue measure predicts aspiration or treatment benefit.
Declared interests
The secondary analysis and manuscript preparation were funded by the first author's National Institute on Deafness and Other Communication Disorders grant DC011020.
The easy way to misread this
Do not treat a visual Eisenhuber score as a precise amount of residue. It disagreed with %-Full pixel classifications, and this paper did not test whether changing the measurement method improves swallowing outcomes.