Residue and clearing time: preliminary considerations in defining dysphagia severity in daily practice

Introduction and aim: In the consideration of swallowing, ‘time’ is a parameter of great interest. The pooling score (p-score), which considers the number of dry swallows needed to clear residue in the pharynx/larynx, can be made more complete by quantifying this parameter, attempting to give a more appropriate and functional criterion of the severity of an impaired swallow. The p-score, enhanced by the inclusion of the time needed to clear residue (timed p-score, tp-score) is put forward for use in clinical practice. Matherial and methods: Two experienced raters blindly evaluated 35 short video clips of 5 cc pureed, 5 cc liquid and 1/4 cracker bolus transits, recorded during the endoscopic evaluations of 16 patients with dysphagia of different aetiologies. For each patient, the time needed to complete the clearing of the boluses (maximum 5 swallows, total time – TT), was determined together with the FOIS and DOSS scales. Results: The average time necessary to clear residue for pureed, solid and liquid boluses was 22.5 s, 30.7 s and 16.6 s respectively. The inter-rater agreement between the 2 raters in applying the p-score was good (ICC > 0.800) for every consistency. A linear regression model documented a statistically significant correlation of the p-score total, the TT and the consistencies with the FOIS and the DOSS, respectively. Discussion and conclusion: The p-score total and the TT are correlated with the severity of dysphagia and the functional activities of the patients, so the pt-score can be useful in clinical practice to define the severity of dysphagia.