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Reliability and Validity of Cervical Auscultation

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Abstract

We conducted a two-part study that contributes to the discussion about cervical auscultation (CA) as a scientifically justifiable and medically useful tool to identify patients with a high risk of aspiration/penetration. We sought to determine (1) acoustic features that mark a deglutition act as dysphagic; (2) acoustic changes in healthy older deglutition profiles compared with those of younger adults; (3) the correctness and concordance of rater judgments based on CA; and (4) if education in CA improves individual reliability. The first part of the study focused on a comparison of the “swallow morphology” of dysphagic as opposed to healthy subjects’ deglutition in terms of structure properties of the pharyngeal phase of deglutition. We obtained the following results. The duration of deglutition apnea is significantly higher in the older group than in the younger one. Comparing the younger group and the dysphagic group we found significant differences in duration of deglutition apnea, onset time, and number of gulps. Just one parameter, number of gulps, distinguishes significantly between the older and the dysphagic groups. The second part of the study aimed at evaluating the reliability of CA in detecting dysphagia measured as the concordance and the correctness of CA experts in classifying swallowing sounds. The interrater reliability coefficient AC1 resulted in a value of 0.46, which is to be interpreted as fair agreement. Furthermore, we found that comparison with radiologically defined aspiration/penetration for the group of experts (speech and language therapists) yielded 70% specificity and 94% sensitivity. We conclude that the swallowing sounds contain audible cues that should, in principle, permit reliable classification and view CA as an early warning system for identifying patients with a high risk of aspiration/penetration; however, it is not appropriate as a stand-alone tool.

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Acknowledgments

The authors thank the patients and control subjects and the SLT teams of the Aatalklinik, Wünnenberg, and the Edith-Stein-Klinik, Bad Bergzabern, the team of the medical practice in Mühlhausen/Thüringen, and the raters from Germany and Switzerland. Special thanks go to Petra Dünger and Stephan Braun. The authors are very grateful to Sönke Stanschus, T. Neil McKaig, Heike Borr, Michael Borr, and Seong-Ji Kim for their general support. Finally, they thank Max Sichelschmidt and the anonymous reviewers for their helpful comments.

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Authors and Affiliations

  1. Department of Clinical Linguistics, Faculty of Linguistics and Literary Studies, Bielefeld, Germany

    Christiane Borr MA & Martina Hielscher-Fastabend HD, Dr.Phil

  2. CRC 673 “Alignment in Communication,” B1, Bielefeld University, Bielefeld, Germany

    Andy Lücking MA

  3. Department of Clinical Linguistics, Faculty of Linguistics and Literary Studies, Bielefeld University, Wittekindstraße 38, 33615, Bielefeld, Germany

    Christiane Borr MA

Authors
  1. Christiane Borr MA
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  2. Martina Hielscher-Fastabend HD, Dr.Phil
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  3. Andy Lücking MA
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Corresponding author

Correspondence to Christiane Borr MA.

Appendix

Appendix

Instructions for raters

  • Please listen to the 33 tracks on the CD. For listening you can use the PC or a standard CD player. The swallowing sounds are played ordered from 1 to 33.

  • Listen to each track as often you feel is necessary.

  • Please don’t confer with your colleagues.

  • Check the appropriate box to rate each swallow as dysphagia, aspiration, younger healthy, older healthy.

  • After listening to the CD please complete the questionnaire, which is related to the basis for your classification.

  • Please answer every question. Do not leave any question blank.

Questions relating to raters’ decision and their experience in the field of dysphagia and CA

  • Please specify the reasons for your classification. Which parameters did you use to diagnose?

  • How many years have you been working with patients suffering from dysphagia?

  • How many years have you been performing cervical auscultation?

  • Where do you place the stethoscope?

  • Have you participated in a special cervical auscultation workshop?

  • How reliable is the method in your opinion?

  • Which other diagnostic methods are used in your institution?

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Borr, C., Hielscher-Fastabend, M. & Lücking, A. Reliability and Validity of Cervical Auscultation. Dysphagia 22, 225–234 (2007). https://doi.org/10.1007/s00455-007-9078-3

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  • DOI: https://doi.org/10.1007/s00455-007-9078-3

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