Utility of Eating Assessment Tool–10 in Predicting Aspiration in Patients with Unilateral Vocal Fold Paralysis

Abstract

Objective: Examine the incidence of penetration/aspiration in patients with unilateral vocal fold immobility and investigate the relationship with self-reported perception of dysphagia. Study Design: Case series with chart review. Setting: Academic cancer center. Subjects and Methods: Adult patients with unilateral vocal fold immobility diagnosed between 2014 and 2016 were reviewed. Patients were stratified into an aspiration group and a nonaspiration group using objective findings on flexible endoscopic evaluation of swallowing, as scored using Rosenbek’s Penetration Aspiration Scale. Objective findings were compared to patient perception of dysphagia. Bivariate linear correlation analysis was performed to evaluate correlation between Eating Assessment Tool–10 scores and presence of aspiration. Tests of diagnostic accuracy were calculated to investigate the predictive value of Eating Assessment Tool–10 scores >9 on aspiration risk. Results: Of the 35 patients with new-onset unilateral vocal fold immobility were evaluated, 25.7% (9/35) demonstrated tracheal aspiration. Mean ± SD Eating Assessment Tool–10 scores were 19.2 ± 13.7 for aspirators and 7.0 ± 7.8 for nonaspirators (P =.016). A statistically significant correlation was demonstrated between increasing Eating Assessment Tool–10 scores and Penetration Aspiration Scale scores (r = 0.511, P =.002). Diagnostic accuracy analysis for aspiration risk in patients with an Eating Assessment Tool–10 score >9 revealed a sensitivity of 77.8% and a specificity of 73.1%. Conclusion: Patient perception of swallowing difficulty may have utility in predicting aspiration risk. An EAT–10 of >9 in patients with unilateral vocal fold immobility may portend up to a 5 times greater risk of aspiration. Routine swallow testing to assess for penetration/aspiration may be indicated in patients with unilateral vocal fold immobility.