| Objective: To compare the differences in silent aspiration and swallowing function among post-stroke patients with pharyngeal dysphagia with varying degrees of abnormal gag reflex, and to explore the correlation between the degree of abnormal gag reflex and silent aspiration. Methods: In total, 120 patients with post-stroke pharyngeal dysphagia were selected. Based on the results of the gag reflex examination, these patients were divided into three groups: normal gag reflex group (group A, n=39), reduced gag reflex group (group B, n=54), and absent gag reflex group (group C, n=27). The videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) were used to assess the occurrence of abnormal swallowing modes, videofluoroscopic dysphagia scale (VDS) scores, penetration aspiration scale (PAS) ratings, Yale pharyngeal residue severity rating scale (YPR-SRS) ratings, the occurrence of pharyngeal sensory impairment and silent aspiration in all three groups. The correlation between the degree of abnormal gag reflex and both swallowing function and silent aspiration was analyzed. Results: There were statistically significant differences among the three groups in terms of delayed triggering of swallow, epiglottis folding dysfunction, abnormal laryngeal uplift, silent aspiration, pharyngeal sensory impairment, and stroke associated pneumonia (P<0.01), with group C having a higher incidence rate than groups A and B (P<0.05), and group B higher than group A (P<0.05). No statistically significant differences were found in pyriform sinus residue, coating of pharyngeal wall, aspiration, VDS scores, PAS and YPR-SRS ratings among the three groups. Correlation analysis revealed that the degree of abnormal gag reflex was positively correlated with delayed triggering of swallow, epiglottis folding dysfunction, abnormal laryngeal uplift, silent aspiration, pharyngeal sensory impairment, and stroke associated pneumonia (P<0.05). The disappearance of the gag reflex predicted a sensitivity of 52.00% and a specificity of 85.26% in identifying silent aspiration in patients. Abnormal gag reflex predicted a sensitivity of 96.00% and a specificity of 40.00% in predicting silent aspiration in patients. Conclusion: The degree of abnormal gag reflex in post-stroke patients is related to the severity of certain pharyngeal swallowing dysfunctions. The higher the degree of abnormal gag reflex, the higher the incidence of silent aspiration may be. |
