Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets

Table 1 Hyodo-Komagane score

A: Salivary pooling in vallecula and piriform sinuses
0	No pooling
1	Pooling at the only vallecula
2	Pooling in vallecula and piriform sinuses and no penetration1 into larynx
3	Pooling in vallecula and piriform sinuses and penetration into larynx
B: The response of glottal closure reflex induced by touching the epiglottis with the endoscope
0	Marked reflex by one touching
1	Slow and/or weak reflex by one touching
2	Reflex by two or three touchings
3	No refex despite three touchings
C: The location of the bolus at the time of swallow onset assessed by "white-out"2 following swallowing of test jelly
0	Pharyngeal
1	Vallecula
2	Piriform sinuses
3	No swallowing
D: The extent of pharyngeal clearance after swallowing of test jelly
0	No residues
1	Pharyngeal residues remain, but are absent after swallowing is attempted two or three times
2	Pharyngeal residues remain, but do not penetrate into larynx
3	Pharyngeal residues remain and penetrate into larynx

¹When saliva or test jelly enters the glottis (opening to the trachea) and moves as far as the vestibule above the true vocal folds, this is termed as “penetration”;

²“white-out” is defined as the period when the videoendoscopic image is obscured owing to pharyngeal closure. Total score (A + B + C + D) = 0-12.

Table 2 Demographic and clinical data in 178 patients who underwent endoscopic evaluation of swallowing

	n (%)
Gender male, female	113 (63), 65 (37)
Mean age range (yr)	83 (66-98)
65-69	11 (6)
70-79	43 (24)
80-89	88 (50)
90 and over	36 (20)
Comorbid diseases
CVD	68 (38)
Aspiration pneumonia	57 (32)
Neuromuscular disease	35 (20)
Others	18 (10)

Values are n (%) of patients except for mean age. CVD: Cerebrovascular disease.

Table 3 Association between Hyodo-Komagane score and oral intake of pureed diets

Score	Oral intake of pureed diets
0-7	Successful 100%
81	Successful in some cases
9-12	Unsuccessful

¹Some patients were able to eat pureed diets after a rehabilitation.