key: cord-1027901-8vfd183p
authors: Sarmet, Max; Dorça, Alessandra; Zeredo, Jorge L.; Esquinas, Antonio M.
title: Letter to the Editor regarding “Dysphagia in non-intubated patients affected by COVID-19 infection”
date: 2021-09-24
journal: Eur Arch Otorhinolaryngol
DOI: 10.1007/s00405-021-07100-0
sha: 077deeb82748307b20d53cc200cba7ddf38f7c96
doc_id: 1027901
cord_uid: 8vfd183p

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risky procedures that cannot be postponed, some countermeasures can be introduced [2, 3] . The authors stated that they chose clinical evaluation because it is a non-aerosol generating procedure. However, clinical evaluation represents a higher risk of transmission of COVID-19 when compared with VFSS [2] .

Second, we noticed a lack of transparency in the demographic data. The authors stated that at the time of evaluation all patients had already overcome the acute phase of the COVID-19 and were therefore asymptomatic but still positive. The information of the mean duration of disease duration among the participants would bring important additional information for the interpretation of the results. The risk of COVID-19 transmission does not justify the absence of VFSS/FEES, as we can see in other similar studies, such as the post-COVID evaluation carried out by Lagier et al. [3] . Nevertheless, some adaptations could certainly be made using noninvasive imaging. Assessments could include methods such as ultrasound [5] , which is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Ultrasound imaging could be adopted as an alternative tool for the objective assessment of swallowing.

The third major concern is the interpretation of the results. Clinical evaluation was considered positive for dysphagia when patients had symptoms like voice changes, cough, and/or desaturation at Volume-Viscosity Swallow Test [1] . Desaturation was interpreted in this case as a sign of bronchoaspiration and, in turn, of dysphagia. However, desaturation is a well-defined characteristic of the acute and post-acute conditions of COVID-19 and certainly influenced their results. Was the etiology of the observed desaturations due to dysphagia, COVID-19, or both? It was probably not by chance that the authors also observed that patients who were positively tested for dysphagia had more previous respiratory diseases (62.5%) than non-dysphagic patients.

Finally, the lack of detailed information about non-invasive ventilation, pulmonary function tests and computed tomography of the lungs prevents readers from better understanding the influence of respiratory and swallowing outcomes. In our opinion, the lack of data on instrumental assessment of swallowing precludes any conclusion about the pathophysiology of the observed dysphagia which should be seen as a phenomenon to be explained. We greatly appreciate the researchers' efforts to research dysphagia even in an unfavorable setting and look forward to Grilli et al. conducting a future study using objective methods for the assessment of swallowing in COVID-19 patients.

Funding None.

The authors report no conflicts of interest and certify that no funding has been received for this study and/or preparation of this manuscript.

Dysphagia in non-intubated patients affected by COVID-19 infection

Assessment, diagnosis, and treatment of dysphagia in patients infected with SARS-CoV-2: a review of the literature and international guidelines

Swallowing function after severe COVID-19: early videofluoroscopic findings

2020) Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic

Ultrasound: an emerging modality for the dysphagia assessment toolkit?