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Chronic Cough and Dysphagia Testing Options

Diagnostic Test Selection in Chronic Cough and Dysphagia

Wednesday, October 14, 8:00 – 9:00 am (ET)


VyVy N. Young, MD

When it comes to diagnostic tests for patients with chronic cough and/or dysphagia, otolaryngologists are faced with a barrage of options. In advance of her session, panelist VyVy N. Young, MD, of the University of California in San Francisco, answered a few questions to help physicians understand their options and the associated pros and cons.

Q: What are the different diagnostic assessment tools available for patients with chronic cough and/or dysphagia?

There are many potential etiologies for chronic cough and dysphagia… and not all of them necessarily overlap. Similarly the workup including diagnostic testing for chronic cough and for dysphagia may be comparable but may not completely intersect. Therefore it is critical for patients first to undergo a thorough history and physical examination—ideally with a multidisciplinary team—to identify which diagnostic tests are most appropriate for their situation and their symptoms.

Evaluation for dysphagia can include laryngoscopy/stroboscopy, Fiberoptic Endoscopic Evaluation of Swallowing (FEES), transnasal esophagoscopy (TNE), barium swallow or esophagram, modified barium swallow study (MBSS)/ Videofluoroscopic Swallowing Study (VFSS), other assessments of the esophagus (such as pH/impedance and manometry), and more.

The etiology for chronic cough is even more diverse. Thus, evaluation and testing for this can encompass assessment for underlying pulmonary disease (e.g., asthma, bronchitis), allergic/sinonasal disease, infectious etiologies (such as pneumonia or pertussis), cardiac disease, gastro-esophageal reflux disease (GERD), in addition to swallowing dysfunction.  Testing can involve imaging (e.g., computed tomography or magnetic resonance imaging studies), pulmonary function studies, laboratory assessments, and more.

Q: Which is the best tool available in terms of expediency?

How fast a patient can access any of the above-mentioned evaluations or tests will be highly dependent on the availability and accessibility of resources at their institution or hospital and in their geographic area. Unfortunately these practical logistical considerations sometimes drive the decision-making toward which test(s) to pursue and in what order, but ideally, selection of the “best” test to assess the patient’s symptoms should be guided by their clinical presentation.

Q: What’s the most cost-effective tool?

Unfortunately, there is no easy answer to this question. The most cost-effective tool is the most precisely selected one that allows you to assess the patient’s symptoms and guide their treatment, without requiring additional, costly tests. The challenge is determining which test that is for each patient, as this will vary.

Q: Which tool is currently most widely used?

The degree of utilization of each of these tests is highly variable, depending on the provider, the practice, the hospital, the geographic area, and a host of other factors. Our hope is that with this presentation, we will be able to increase otolaryngologist’ awareness of the numerous tests that are available and to help them understand which one(s) may be most helpful in which clinical scenario(s).

Q: Would you recommend that otolaryngologists prioritize the usage of any one or two of these assessment tools? Or should they keep all of them in mind depending on the specific variables involved in individual cases?

Selection of the most appropriate assessment tool for each individual patient should be directed by the patient’s symptoms and clinical history. Comprehensive evaluation of the patient should guide the clinician’s decision-making in this regard. The purpose of our presentation at the AAO-HNSF Virtual Annual Meeting is to demonstrate how best to utilize these factors in the application of these diagnostic tests in a strategic, logical, and cost-effective manner.

If you miss this live event, it will become available in the on-demand library of education content within 72 hours following the presentation.