Video-Audio Synching Trial in Swallowing
Aspiration pneumonia (pneumonia caused by swallowed solids or liquids entering the lungs) is a leading cause of morbidity and mortality in the world, especially among the elderly and those with neurologic disorders. It is most often caused by the presence of a swallowing disorder (dysphagia), which is itself usually only discovered after the fact when a patient presents with an episode of aspiration pneumonia and then undergoes testing. Selected high-risk patients (e.g., stroke victims) are also routinely sent for testing for the presence of dysphagia. At present, the two most common methods for testing are the modified barium swallow (MBS) and fiber-optic endoscopic evaluation of swallowing (FEES). MBS requires radiation exposure, and can only be performed in hospital or mobile radiology facilities. FEES is an invasive procedure that can be uncomfortable and requires specially trained personnel.
The possibility of detecting the presence of dysphagia by listening to the sounds produced during a swallow has been discussed in the medical literature for decades. However, it has not been used due to technical challenges (the lack of a good “stethoscope-like” device to listen with) as well as the lack of an understanding of how to interpret the sounds that are obtained. The goal is to develop a simple, sound-based noninvasive bedside screening tool for the presence of dysphagia that would allow for rapid testing that can be performed easily, as often as required (e.g., monthly screening in high risk patients) and at low cost.
The Video-Audio Synching Trial in Swallowing (VASTS) is exploring whether we can test for the presence of a swallowing disorder by analyzing swallow sounds captured using a novel, external stethoscope-like device developed at BMHT in conjunction with MDPS™ processing. Patients with suspected dysphagia who are referred for MBS studies undergo simultaneous swallow sounds recording. The sounds are synched with the video from the MBS and the sounds are correlated with the events seen on the video. From these results criteria for determining a positive and negative screening result, to know which patients may need further referral for an MBS or FEES.