Silent aspiration lacks clinical manifestations and easily leads to complications such as aspiration pneumonia. At present, there is a lack of research on the current status of silent aspiration and its influencing factors in patients with dysphagia in China.
To understand the current status of silent aspiration among patients with dysphagia in China and to explore the influencing factors of silent aspiration.
This study was a cross-sectional survey. 212 patients with dysphagia were selected as study subjects among the rehabilitation, neurosurgery, and neurology departments of four hospitals in Nanjing (the First Affiliated Hospital with Nanjing Medical University, the Affiliated Jiangning Hospital of Nanjing Medical University, the Affiliated Sir Run Run Hospital of Nanjing Medical University, and the Dongshan Hospital of Jiangning District of Nanjing) by the convenience sampling method from December 2022 to January 2024. The basic data of the patients were recorded, and the Eating Assessment Questionnaire (EAT-10) score and Barthel Index were used to assess dysphagia risk and ability to perform activities of daily living. Fluoroscopic Fluorescence Swallowing Screening (VFSS) or Flexible Endoscopic Swallowing Function Examination (FEES) was used to diagnose whether the patient experienced aspiration and the type of aspiration. In this study, all patients who had no aspiration during swallowing were categorized as the no aspiration group, all patients who had at least 1 silent aspiration during swallowing were categorized as the silent aspiration group, and all patients who had at least 1 overt aspiration but no silent aspiration during swallowing were categorized as the overt aspiration group. Multivariate Logistic regression analysis was used to explore the influencing factors of silent aspiration and overt aspiration.
Silent aspiration accounted for 47.2% (100/212), overt aspiration 13.2% (28/212), and no aspiration 39.6% (84/212) of patients with dysphagia. Among the 128 patients with aspiration, 78.1% (100/128) were silent aspiration and 21.9% (28/128) were overt aspiration. The results of multivariate Logistic regression analysis showed that the EAT-10 score (OR=1.076, 95%CI=1.028-1.126, P=0.002), gender (female as control, OR=2.231, 95%CI=1.103-4.509, P=0.025), and conscious status (impaired consciousness as control, OR=0.334, 95%CI=0.123-0.911, P=0.032) were influential factors for silent aspiration. EAT-10 scores (OR=1.113, 95%CI=1.046-1.184, P=0.001) and poor self-assessed health (OR=0.194, 95%CI=0.041-0.923, P=0.039) were influential factors for overt aspiration.
The prevalence of silent aspiration is higher among patients with dysphagia and the risk of silent aspiration increases with higher EAT-10 scores, in males, and in those with impaired consciousness.
Swallowing dysfunction is a common complication after stroke, and the recovery of swallowing function is important regarding patients' intake of nutrients, improved quality of life, reduced risk of complications, and improved quality of life. Although intermittent θ burst stimulation (iTBS) and chin tuck against resistance (CTAR) have been shown to have significant effects in improving dysphagia, fewer studies have been performed on combining iTBS with CTAR in the treatment of patients with dysphagia in stroke, and its rehabilitative effects need to be further investigated.
To observe the clinical effects of iTBS combined with CTAR training on swallowing function in stroke patients.
From March 2023 to July 2024, 90 patients with post-stroke dysphagia attending the Department of Rehabilitation Medicine of the First Affiliated Hospital of Bengbu Medical University were selected. The patients were randomly divided into the routine group (n=30), the CTAR group (n=30), and the combined group (n=30) according to the method of random number table. The routine group received conventional swallowing training, the CTAR group received CTAR training based on the routine group, and the combined group received iTBS based on the CTAR group. Both groups received treatment five times per week for four weeks. The Standard Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS) were used before and after the treatment. Surface electromyography (sEMG) was used to measure the duration of swallowing and the maximum amplitude value of the supraglottic muscle group and to compare the clinical effects of the three groups of patients.
Thirty cases in the routine group, 30 cases in the CTAR group, and 30 cases in the combined group were finally included. After 4 weeks of treatment, the SSA score of the patients in the three groups was lower than those before treatment in the group, the FOIS score and the maximum amplitude value of sEMG were higher than those before treatment in the group, and the duration of swallowing was shorter than those before treatment in the group (P<0.05). After 4 weeks of treatment, the SSA score of the patients in the CTAR group and the combined group was lower than those in the routine group, the FOIS score and the maximum amplitude value of sEMG in the CTAR group and the combined group were higher than those in the routine group, and the duration of swallowing in the CTAR group and the combined group was shorter than those in the routine group (P<0.05) ; the SSA score of the patients in the combined group was lower than those in the CTAR group, the FOIS score and the maximum amplitude value of sEMG in the combined group were higher than those in the CTAR group, and the duration of swallowing in the combined group was shorter than those in the CTAR group (P<0.05). And the overall effective rate of the CTAR group and the combined group was higher than that of the routine group (P<0.017), and the overall effective rate of the combined group was higher than that of the CTAR group (P<0.017) .
CTAR combined with iTBS can improve the swallowing function of stroke patients with dysphagia, reinforce the strength of swallowing muscle groups, and enhance their quality of life.
Post-stroke dysphagia (PSD) is a common and severe complication of stroke, significantly reducing patients' quality of life and increasing mortality risk. Although multiple factors have been proposed to correlate with PSD prognosis, the quality of evidence supporting these associations remains systematically underevaluated.
To systematically evaluate risk and protective factors influencing PSD prognosis and assess the quality of evidence for each factor.
Eight databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, VIP, and SinoMed) were searched from their inception to November 3, 2024 to identify systematic reviews investigating prognostic factors for PSD. The methodological quality of the included reviews was appraised using the AMSTAR 2 checklist. A four-tiered evidence grading system was applied to evaluate the certainty of the prognostic factors. Data from all relevant original studies within the systematic reviews were synthesized and re-analyzed using Stata 16 and RevMan 5.4.
Five systematic reviews (encompassing 39 original studies) were included, identifying 45 prognostic factors associated with PSD. Only one factor (impaired consciousness) was supported by strong evidence. Nine factors—age, sex, cognitive impairment, dysphagia severity, malnutrition, bilateral stroke, activities of daily living, NIHSS score, and mRS score—demonstrated highly suggestive evidence, while the remaining factors were supported by weak evidence.
Prognostic factors for PSD can be categorized into reversible and irreversible determinants. Clinical interventions should prioritize modifiable factors to optimize rehabilitation outcomes. Further high-quality studies are warranted to validate these associations and refine evidence-based management strategies.
Dysphagia is common among elderly people and may lead to aspiration, malnutrition, and pulmonary infections if not properly managed. Acoustic-based assessment offers a non-invasive, practical, and remotely applicable approach, yet current research is limited by small sample sizes and a lack of standardized data protocols. This study recruited 650 older adults from 13 care institutions in Beijing and Shijiazhuang, with 635 completing valid audio tasks. A total of 7 922 high-quality recordings were collected, including swallowing, coughing, and speech sounds. From each audio clip, 23 acoustic features across time, frequency, energy, and nonlinear domains were extracted, yielding 182 206 feature data points. Waveform, spectrogram, and time-frequency analyses confirmed significant differences across sound types, highlighting the discriminative value of acoustic features. A standardized workflow for audio collection, processing, and feature extraction was developed, resulting in a comprehensive swallowing acoustic database. This database provides essential support for recognizing acoustic biomarkers, building AI-driven identification models and advancing remote dysphagia assessment. It has significant scientific research value and broad application prospects.
