**4.3 Statistical correlations**

Statistically significant correlation between some of the results of functional assessment at rest and speech and the WST results were found.

In case of the functional assessment at rest, a positive 5 ml WST result was found only in patients with increased submandibular and pharyngeal walls muscle tension (both p = .03), and for 10 ml WST in patients with increased SCM tension on the left side (p = .03) and for 10 and 20 ml WST in subjects with upper chest breathing pattern (p = .04 and p = .01, respectively).

In case of functional assessment at speech, the upper chest breathing pattern correlated with abnormal WST results. All patients with upper chest breathing pattern demonstrated positive WST result for 10 and 20 ml liquid test (p = .06 and p = .01, respectively).

*Assessment of Dysphagia as a Risk Factor of Chronic Cough DOI: http://dx.doi.org/10.5772/intechopen.97038*

On physical examination the following was found: normal pharyngeal reflexes in 23 patients, normal soft palate activity during swallows in 29 patients, and impaired elevation of the larynx in 10 (**Figure 1**). However, only the impaired elevation of the larynx was correlated with the abnormal 5 ml WST results (p = .03).

In case of WST results, the negative (no risk of aspiration) result was found in 28 patients (93.33%) for 5 ml amount of liquid, in 24 (80.00%) for 10 ml, in 21 (70.00%) for 20 ml, and in 15 (50.00%) for 90 ml (**Figure 2**). The remaining patients demonstrated positive WST result, which is associated with the risk of aspiration and requires verification by the objective diagnostic methods like FEES and/or videofluoroscopy

#### **4.4 Other results**

In FEES examination, in 5 patients (16.67%) small palato-pharyngeal insufficiency was found, and in almost all patients (29 subjects, 96.67%) enlarged lingual tonsil and laryngopharyngeal reflux symptoms. Laryngeal closure and squeeze maneuver (pharyngeal wall motions during phonation) were normal in most of the patients: vocal folds closure during cough (30 subjects, 100%), Valsalva maneuver (26 subjects, 86.67%), squeeze maneuver (28 subjects, 93.33%). Two patients (6,67%) did not show any of the spontaneous swallows. Retention of saliva at the level of the hypopharynx and larynx was found in 27 patients (90.00%).

The FEES evaluation of different food consistencies revealed (**Figures 3–6**):


**Figure 3.** *Fiberoptic endoscopic examination of swallowing (FEES) - anatomy and physiology of the pharynx and larynx.*

#### **Figure 4.**

*Fiberoptic endoscopic examination of swallowing (FEES) - swallowing of different food consistency.*

#### **Figure 5.**

*Fiberoptic endoscopic examination of swallowing (FEES) - liquid penetration (blue arrow), residue in the piriform sinuses (green arrows).*


Also between the FEES and WST some associations were found. The 5 ml WST result was found to be positive only in patients with retention of thick mucus in

#### **Figure 6.**

*Fiberoptic endoscopic examination of swallowing (FEES): Spillage (green arrows), residue in the piriform sinuses (blue arrow).*

nasopharynx (p = .015). Half of the patients with 10 ml positive WST result presented risk of aspiration (p = .014), and only in 1 patient out of 18 with no FEES abnormal findings the 10 ml WST result was positive (p = .02). All patients with weakened squeeze maneuver presented positive 20 ml WST result (p = .025). For 90 ml WST no statistically significant results were found.
