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Cranial Nerve Examination for Neurogenic Dysphagia Patients

Isabella Koch,Agnese Ferrazzi,Claudio Busatto,Laura Ventura,Katie Palmer,Paola Stritoni ,Francesca Meneghello,Irene Battel

This cross-sectional study aimed to validate a cranial nerve assessment for swallowing against fiber optic-endoscopic examination of swallowing (FEES) in a group of neurological patients. A specific cranial nerve evaluation was designed, comprising semi-qualitative evaluations of the main five cranial nerves involved in swallowing. Eighty-five participants were consecutively recruited with the following inclusion criteria were: a) neurological diagnosis; b) ability to respond to simple verbal command; c) absence of citrus allergy and age<18 years. All participants first underwent cranial nerve examination (the “I&I” test), followed by a FEES conducted by a blinded otolaryngologist who completed the penetration aspiration scale (PAS) and the functional oral intake scale (FOIS). The results showed that I&I test had a high sensitivity (0.89) and specificity (0.93) for identify dysphagia in persons with neurologic disorders, with an area under ROC curve of 0.97. Significant differences were found from the comparison between I&I test scores and the three severity levels of PAS. In conclusion, the I&I test is a useful scale to detect the major deficits affecting the cranial nerves in patients with swallowing disorders. In addition, it allows defining the pathophysiological dysphagia symptoms, which are fundamental for planning the customized rehabilitation interventions.