E11 The Role of Cough Reflex Testing in Detecting Silent Aspiration Risk with Dr Phoebe Macrae
Dysphagia Research BitesShow Notes
Let's unpack the evidence on cough reflex testing: what it tells us, what it doesn't, and whether clinicians are making a dangerous assumption when Cough Reflex Testing (CRT) results aren't available.
In this episode we cover:
What cough reflex testing is and how it works as a screening tool for silent aspiration risk The key finding from Phoebe's research: a failed CRT leads to significantly more restrictive management, but in the absence of any CRT result, clinicians manage patients almost identically to those who passed What that pattern reveals about our default assumptions around airway sensation How aspiration pneumonia risk factors influenced clinician decision-making in the study The sensitivity and specificity of CRT and why it's not a perfect predictor of aspiration The complexity of interpreting CRT results across different textures — including patients who silently aspirate on thickened fluids after overtly aspirating on thin Why Phoebe frames CRT as one piece of a bigger clinical picture, not a standalone decision-making tool What Phoebe would want her own caregivers to know if she ever developed dysphagia
The publication this episode is based on: Darrock, K., Wallace, E., Guiu Hernandez, E., Huckabee, M.-L., Mills, M., & Macrae, P. (2024). The influence of cough reflex testing on patient management. Journal of Speech, Language, and Hearing Research, 67, 2987–2996. https://doi.org/10.1044/2024_JSLHR-24-00174
Other articles mentioned:
Miles A, Zeng IS, McLauchlan H, Huckabee ML. Cough reflex testing in Dysphagia following stroke: a randomized controlled trial. J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23. PMID: 23671548; PMCID: PMC3651073. https://pubmed.ncbi.nlm.nih.gov/23671548/
Miles A, Moore S, McFarlane M, Lee F, Allen J, Huckabee ML. Comparison of cough reflex test against instrumental assessment of aspiration. Physiol Behav. 2013 Jun 13;118:25-31. doi: 10.1016/j.physbeh.2013.05.004. Epub 2013 May 12. PMID: 23672854. https://pubmed.ncbi.nlm.nih.gov/23672854/
For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course
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