[Dysphagia] Cervical Auscultation

[DRolfe at nsccahs.health.nsw.gov.au (Deanna Rolfe)]

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HI All,

I did a course "Developing skills in cervical auscultation" here in Australia last year, run by Julie Cichero.

Please contact Speech Pathology Australia if you would like to get in contact with her, as she was a guest speaker organised by the association.
She had a huge reference list in the booklet...too many for me to re-type and e-mail to everyone...but she may have it on file somewhere.

Things I took away from the course...
1) Use cervical auscultation as an adjunct to your usual bedside evaluation...not replace it. Cervical auscultation can add more information to assist decision making.

2) CA can assist in determining if a swallow is "abnormal" vs "normal"...there are lots of sounds you can hear, and after listening to lots and lots of patient,s you build up an internal data base of what is a "normal" sounding swallow, and what is not...e.g. a normal swallow should have 3 clicks, crisp/quick sounds, no change in respiration rate/sounds after the swallow as compared with before...an abnormal swallow sounds very different (and not always the same!)...I've heard squelching, high pitched squeaks, clunking, gurgling/wet sounds, increased respiratory rate, clicks that are not quick/crisp...etc, etc...
I personally can also hear how prompt a swallow is...e.g. premature spillage of fluids is often heard as a "gushing" sound...versus someone who is holding it in their mouth successfully (but on bedside could be mistaken as a delayed swallow?)

3) CA is subjective...we may all hear things sightly differently, but from what Julie said, the research she presented shows reliability across clinicians.

In response to your colleague claiming to be able to hear solids pooling in the pyriforms...well, me personally...I'm not that good!!
I can identify pooling in the pharyngeal area (or at least hypothesise that the sounds I'm hearing is pooled material), but I'm not able to localise where exactly it is pooling.

I often use CA to compare a number of consistencies during a trial, e.g. thickened fluid versus thin fluid (I know these will sound a little different anyway due to viscosity, but sometimes big differences can be very clearly heard that indicate the person isn't managing one or the other).

Hope this helps a little...I find it a great addition to the bedside assessment.

Deanna

Deanna Rolfe
Senior Speech Pathologist
Hornsby Hospital
Sydney, Australia

>>> <mdspeech@verizon.net> 07/01/2006 5:26:10 PM >>>
Despite growing clinical use, cervical auscultation suffers from a lack of research-based data. One of the strongest criticisms of cervical auscultation is that there has been little research to demonstrate how dysphagic swallowing sounds are different from normal swallowing sounds.

That being said, exactly what valuable information are clinicians able to obtain when listening to someone swallow using a stethescope during cervical auscultation.

So far I've only been able to find only a little subjective information pertaining to the timing of the apneic period during the swallow as well as clarity of the respirations. There are also reports of the perceptual identity of any attempts at laryngeal clearing or impeded airflow in the larynx.

How does one translate and document this information into dysphagic vs non-dysphagic swallowing? Furthermore, is there anything else of value that is obtained by using this during a clinical bedside swallowing examination.

I happen to work with fellow clinician who claims she can hear pooling in the pyriform sinuses with solids. This seems a little far fetched, but she seems hell bent on continuing to make these preposterous claims....I digress...

I know that this topic has been covered before, but my review of the archives has yet to uncover any valuable information.

Any help would be greatly appreciated.
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