Precise assessment of the risk of aspiration is critical in older patients with a history of pneumonia. However, the currently popular videofluoroscopic and videoendoscopic examinations of swallowing only evaluate volitional swallowing. A method for quantitative analysis of reflexive swallowing is not yet available.
We evaluated volitional swallowing in the sitting position by videoendoscopic examination and then measured the volume of injected water that triggered reflexive swallowing in the supine position in 54 patients with a history of pneumonia and 24 control patients of a similar age who had no history of pneumonia.
The volume of injected water that triggered reflexive swallowing was larger in the pneumonia group than in the control group (mean, 1.64 +/- 0.61 mL versus 0.71 +/- 0.28 mL; p < 0.001). Both impaired volitional swallowing and impaired reflexive swallowing independently correlated with a history of pneumonia.
The endoscopic supine swallow-evoking test (“ESSET”) may detect previously omitted risk factors for aspiration in patients who can volitionally swallow.