Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration

SummaryAimsTo determine the accuracy of the bedside volume–viscosity swallow test (V-VST) for clinical screening of impaired safety and efficacy of deglutition.MethodsWe studied 85 patients with dysphagia and 12 healthy subjects. Series of 5–20 mL nectar (295.02 mPa.s), liquid (21.61 mPa.s) and pudding (3682.21 mPa.s) bolus were administered during the V-VST and videofluoroscopy. Cough, fall in oxygen saturation ≥3%, and voice changes were considered signs of impaired safety, and piecemeal deglutition and oropharyngeal residue, signs of impaired efficacy.ResultsVideofluoroscopy showed patients had prolonged swallow response (≥1064 ms); 52.1% had safe swallow at nectar, 32.9%, at liquid (p < 0.05), and 80.6% at pudding viscosity (p < 0.05); 29.4% had aspirations, and 45.8% oropharyngeal residue. The V-VST showed 83.7% sensitivity and 64.7% specificity for bolus penetration into the larynx and 100% sensitivity and 28.8% specificity for aspiration. Sensitivity of V-VST was 69.2% for residue, 88.4% for piecemeal deglutition, and 84.6% for identifying patients whose deglutition improved by enhancing bolus viscosity. Specificity was 80.6%, 87.5%, and 73.7%, respectively.ConclusionsThe V-VST is a sensitive clinical method to identify patients with dysphagia at risk for respiratory and nutritional complications, and patients whose deglutition could be improved by enhancing bolus viscosity. Patients with a positive test should undergo videofluoroscopy.