ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2025
Diagnostic accuracy of the gugging swallowing screen (GUSS) in detecting aspiration and dysphagia in patients with unilateral vocal fold paralysis.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeIn unilateral vocal fold paralysis (UVFP), accurate detection of swallowing disorders is crucial to prevent potential complications. Given the limited feasibility of instrumental assessments in everyday clinical practice, there is a need for validated, condition-specific screening tools. This preliminary study aimed to evaluate the diagnostic accuracy of the Gugging Swallowing Screen (GUSS) in detecting oropharyngeal dysphagia, penetration, and aspiration in patients with UVFP.
methodsA prospective clinical study was conducted involving 31 patients diagnosed with UVFP. All participants underwent both GUSS and fiberoptic endoscopic evaluation of swallowing (FEES). FEES served as the reference standard for assessing swallowing safety and assigning Penetration-Aspiration Scale (PAS) scores. Inter-rater reliability of PAS scoring was assessed using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) analyses were used to determine the sensitivity, specificity, and predictive values of GUSS in detecting aspiration and penetration events.
resultsFEES identified signs of dysphagia in 41.9% of participants, with aspiration present in 38.5% of these cases. Inter-rater agreement for PAS scoring via FEES was excellent (ICC = 0.95). GUSS demonstrated a sensitivity of 100% and specificity of 73% for detecting aspiration (PPV: 41%, NPV: 100%, LR+: 3.70, LR-: 0.00). For dysphagia/penetration, sensitivity was 92% and specificity 83% (PPV: 80%, NPV: 93%, LR+: 5.41, LR-: 0.09). A strong correlation was found between dietary recommendations based on GUSS and those derived from FEES (r = 0.641, p < 0.05).
conclusionThese findings support the clinical validity of GUSS as a reliable screening tool for detecting dysphagia and aspiration risk in patients with UVFP. While not a substitute for comprehensive instrumental assessment, GUSS may facilitate diagnostic screening and referral, ultimately improving dysphagia management in this high-risk population.
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