Making certain and timely assessment of dysphagia disorders means improving the quality of life of those affected. But what are the most common diagnostic tests?

Dysphagia is a disorder that affects about 20% of the Italian population over 50. In particular, significant swallowing difficulties are found in Parkinson's disease patients (50-90%), stroke patients (40-80%) and the multiple sclerosis population (33-43%). In addition to these figures, there is a percentage of people who suffer from dysphagia, however, for which a precise diagnosis has not yet been made. We are talking about a percentage as high as 95%. This is another reason why acertain and timely assessment of the disorder is essential, so that all possible measures can be put in place to improve the quality of life of those affected. But how is an evaluation of dysphagia performed? What are the most common diagnostic tests?

An important prerequisite for any dysphagia evaluation test is the patient's state of consciousness. If the subject is not awake or has dyspnea, no swallowing test can be conducted. In addition, before moving on to the actual tests, a data collection and interview of the patient is essential as an integral part of the assessment phase.

Having carried out these preliminary tests, one can start with dysphagia screening tests. The most common are as follows:

Gugging Swallowing Screen (GUSS)

This is an international clinical examination that consists of two stages:

• Indirect assessment of swallowing function
• Direct swallowing tests of substances of semisolid, liquid and solid consistencies.

Each patient examined is given a score (from 0 to 20) that determines the degree and category of dysphagia.

Three-oz Water Swallow test (WST, Smithard's Test)

This dysphagia assessment test involves administering 5ml of room-temperature water to the patient with a spoon 3 times and, each time, checking for swallowing. If the patient has episodes of severe coughing or gurgling voice, the test is discontinued. In that case, a grade 4 (Severe Dysphagia) will be found. If, on the other hand, the patient does not cough, we proceed by offering him or her water directly from a glass and, after a few seconds, assess the quality of his or her voice. If a hoarse and/or gurgling voice and cough are also found in this case, the patient is classified with grade 3 (Moderate Dysphagia). On the other hand, when only a hoarse and/or gurgling voice is found, a grade 2 (Mild Dysphagia) is assigned. If the test is negative, a new test is performed, this time with 50ml of water. If again the patient has no swallowing difficulty, a grade 1 (Absent Dysphagia) may be ascertained. 

Finally, it is worth mentioning that there are two variants of this test: the pulse oximeter-sensitized WST and the auscultation-sensitized WST.

Bedside Swallowing Assessment

Very similar to the WST, this is a test in which the patient is given a teaspoon of room temperature water. After 10-15 seconds there is eventual gurgling of the voice and coughing episodes. If the patient responds positively, this is followed by administering 50ml of water and noting evidence of pharyngeal stagnation, coughing, or gurgling over the next few minutes. Each finding is given a score that will determine the presence or absence of dysphagia. The Bedside Swallowing Assessment also involves the evaluation of parameters such as level of consciousness, head and torso control, and breathing.

Daniels test

It corresponds to a chart in which the 6 symptoms of aspiration are reported: dysphonia, dysarthria, voluntary cough, reduced post-swallow cough, altered or absent nausea reflex, and changes in voice after swallowing. A case of dysphagia is established in the presence of at least two of these symptoms.