Utility of ultrasound in the assessment of swallowing and laryngeal function: a rapid review and critical appraisal of the literature
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID‐19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non‐invasive, non‐aerosol‐generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature.
Aim
To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults.
Methods & Procedures
A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS‐2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration.
Outcomes & Results
Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer‐reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3–100% and 48.5–100%, respectively.
Conclusions & Implications
There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a tool in isolation. Further research is required to establish reliability in US assessment as well as clear SLT‐driven protocols and training.
Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID‐19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non‐invasive, non‐aerosol‐generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature.
Aim
To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults.
Methods & Procedures
A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS‐2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration.
Outcomes & Results
Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer‐reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3–100% and 48.5–100%, respectively.
Conclusions & Implications
There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a tool in isolation. Further research is required to establish reliability in US assessment as well as clear SLT‐driven protocols and training.
Date Issued
2021-01
Date Acceptance
2020-10-13
Citation
International Journal of Language & Communication Disorders, 2021, 56 (1), pp.174-204
ISSN
1368-2822
Publisher
Wiley
Start Page
174
End Page
204
Journal / Book Title
International Journal of Language & Communication Disorders
Volume
56
Issue
1
Copyright Statement
© 2020 Royal College of Speech and Language Therapists. This is the peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12584. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Identifier
https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12584
Subjects
Science & Technology
Social Sciences
Life Sciences & Biomedicine
Audiology & Speech-Language Pathology
Linguistics
Rehabilitation
acquired
adults
dysarthria
dysphagia
neurodegenerative diseases
PHARYNGEAL WALL-MOTION
OROPHARYNGEAL DYSPHAGIA
ULTRASONOGRAPHY
QUALITY
RESIDUE
ASPIRATION
MOVEMENT
MOBILITY
TONGUE
TOOL
1103 Clinical Sciences
1702 Cognitive Sciences
2004 Linguistics
Speech-Language Pathology & Audiology
Publication Status
Published
Article Number
1460-6984.12584
Date Publish Online
2020-12-04