Association of fluid volume and sequential swallowing method with videofluoroscopic swallow study findings in patients with dysphagia : A retrospective observational study
- 1Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
- 2Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
Abstract
Accurate assessment of aspiration is critical for managing dysphagia, yet conventional videofluoroscopic swallow study (VFSS) protocols using small fluid volumes may not reflect real-life dietary conditions. This study aimed to evaluate aspiration during large-volume and sequential swallowing tasks in comparison with the standard 5 mL swallow test. We conducted a retrospective single-center observational study using VFSS data from 53 patients with neurogenic dysphagia. A total of 159 swallowing observations from the same 53 patients were analyzed across 3 swallowing conditions (a repeated-measures design): 5 mL swallow, large-volume swallow, and sequential swallowing, all mixed with barium. Aspiration was determined using the Penetration-Aspiration Scale, with a score of ≥5 indicating aspiration. Kinematic parameters, including laryngeal elevation distance, duration, velocity, and pharyngeal transit time, were analyzed. Aspiration occurred in 11 patients during the 5 mL test, and in 16 patients each during both large-volume and sequential swallowing; this difference was not statistically significant in the repeated-measures analysis. Sequential swallowing showed significantly reduced laryngeal elevation distance and duration compared with the other tests, whereas the large-volume test showed significantly greater laryngeal elevation distance and duration than the 5 mL test (P = .005 and P = .011, respectively). Pharyngeal transit time also differed significantly across conditions (P = .003), although the effect size was small (Kendall’s W = 0.107). In the 5 mL condition, patients with aspiration had a significantly slower laryngeal elevation velocity than those without aspiration. In the exploratory within-condition comparisons, no other differences between the aspiration and non-aspiration groups reached statistical significance. These findings suggest that aspiration events were numerically more frequent during the large-volume and sequential swallowing tasks than during the conventional 5 mL test, although this difference was not statistically significant in the repeated-measures analysis. Standard VFSS protocols using small-volume swallows may not fully reflect aspiration patterns encountered during routine eating and drinking. Including large-volume and sequential swallowing tasks during VFSS may provide additional information for the assessment of aspiration risk in patients wishing to return to a regular diet. These findings should be interpreted with caution given the retrospective design and relatively small cohort size.
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BibTeX
@article{oh2026association,
title = {{Association of fluid volume and sequential swallowing method with videofluoroscopic swallow study findings in patients with dysphagia : A retrospective observational study}},
author = {Byeong-Hun Oh and Tae-Seok Chae and Da-Sol Kim and Yu-Hui Won and Sung-Hee Park and Myoung-Hwan Ko and Jeong-Hwan Seo and Gi-Wook Kim},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051379},
url = {https://europepmc.org/article/PMC/PMC13727160},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of fluid volume and sequential swallowing method with videofluoroscopic swallow study findings in patients with dysphagia : A retrospective observational study
AU - Byeong-Hun Oh
AU - Tae-Seok Chae
AU - Da-Sol Kim
AU - Yu-Hui Won
AU - Sung-Hee Park
AU - Myoung-Hwan Ko
AU - Jeong-Hwan Seo
AU - Gi-Wook Kim
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051379
UR - https://europepmc.org/article/PMC/PMC13727160
AB - Accurate assessment of aspiration is critical for managing dysphagia, yet conventional videofluoroscopic swallow study (VFSS) protocols using small fluid volumes may not reflect real-life dietary conditions. This study aimed to evaluate aspiration during large-volume and sequential swallowing tasks in comparison with the standard 5 mL swallow test. We conducted a retrospective single-center observational study using VFSS data from 53 patients with neurogenic dysphagia. A total of 159 swallowing observations from the same 53 patients were analyzed across 3 swallowing conditions (a repeated-measures design): 5 mL swallow, large-volume swallow, and sequential swallowing, all mixed with barium. Aspiration was determined using the Penetration-Aspiration Scale, with a score of ≥5 indicating aspiration. Kinematic parameters, including laryngeal elevation distance, duration, velocity, and pharyngeal transit time, were analyzed. Aspiration occurred in 11 patients during the 5 mL test, and in 16 patients each during both large-volume and sequential swallowing; this difference was not statistically significant in the repeated-measures analysis. Sequential swallowing showed significantly reduced laryngeal elevation distance and duration compared with the other tests, whereas the large-volume test showed significantly greater laryngeal elevation distance and duration than the 5 mL test (P = .005 and P = .011, respectively). Pharyngeal transit time also differed significantly across conditions (P = .003), although the effect size was small (Kendall’s W = 0.107). In the 5 mL condition, patients with aspiration had a significantly slower laryngeal elevation velocity than those without aspiration. In the exploratory within-condition comparisons, no other differences between the aspiration and non-aspiration groups reached statistical significance. These findings suggest that aspiration events were numerically more frequent during the large-volume and sequential swallowing tasks than during the conventional 5 mL test, although this difference was not statistically significant in the repeated-measures analysis. Standard VFSS protocols using small-volume swallows may not fully reflect aspiration patterns encountered during routine eating and drinking. Including large-volume and sequential swallowing tasks during VFSS may provide additional information for the assessment of aspiration risk in patients wishing to return to a regular diet. These findings should be interpreted with caution given the retrospective design and relatively small cohort size.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -