The combination of swallowing evaluations may be useful for the prediction of aspiration pneumonia in patients with Duchenne muscular dystrophy (DMD), according to a study published in Auris Nasus Larynx.

Combining the modified water swallowing test (MWST) and the flexible endoscopic evaluation of swallowing (FEES) for evaluating the Hyodo score was able to predict the onset of aspiration pneumonia within 2 years.

Using a cutoff score of less than 4 on the MWST yielded a statistically significant difference (P =.0347) between the group of patients who experienced pneumonia and the group that did not. The sensitivity and specificity of using this predictor were .57 and .79, respectively.

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A Hyodo score cutoff of 6 also yielded a significant difference between groups (P =.0276) with a sensitivity of .50 and a specificity of .828. While both of these predictors yielded low sensitivities individually, their combination improved the value to .79 but did decrease the specificity to .69.

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“Combining MWST and FEES (the Hyodo score) is the most effective for predicting the onset of aspiration pneumonia in patients with DMD,” the authors wrote. “Although endoscopy is required for performing the FEES, this examination can be performed easily, even for patients on [noninvasive positive pressure ventilation].”

The study also found a positive correlation between patient age and Hyodo score (R =.607; P <.001). These results suggest a worsening in swallowing ability as DMD patients age. No significant difference was found for age between the patients who developed pneumonia and those who did not, however.

A total of 43 Japanese patients with DMD were included in the study at a single clinical site between 2015 and 2018. The mean age of the patients was 28.1 years with a range of 16 to 47 years. Aspiration pneumonia developed in 14 (32.6%) of the patients within 2 years of evaluation.


Kawamoto-Hirano A, Ikeda R, Takahashi T, et al. Bedside evaluation of swallowing function to predict aspiration pneumonia in Duchenne muscular dystrophy. Auris Nasus Larynx. Published online August 13, 2022. doi:10.1016/j.anl.2022.07.006