Dysphagia is an important complication of acute stroke. Abnormal lip closure, lingual incoordination, and delayed or absent triggering of the swallowing reflex may lead to a disturbance of both the oral and the pharyngeal phase of swallowing. In the acute stage of the illness dysphagia is found in up to 76% of patients [1–6], while dysphagic symptoms resolve in most of them within two weeks and persist in only a small number of subjects beyond six months [2–4]. Due to aspiration, malnutrition and dehydratation, dysphagia is associated with chest infection, prolonged hospital stay, institutionalisation and increased mortality [2, 7–10].
Based on the results of the FOOD study early feeding via a nasogastric tube (NGT) is usually recommended as safe way of supplying nutrition in acute stroke patients . There is, however, preliminary evidence that NGTs themselves interfere with swallowing physiology. Comparing NGT feeding with feeding via a percutaneous endoscopic gastrostomy (PEG) in a mixed collective of patients with neurological, ear, nose and throat or surgical problems Baeten and Hoefnagels reported swallowing difficulties in 17.4% of NGT-fed patients as opposed to none in the PEG group . Furthermore, in a study of young and healthy volunteers Huggins and co-workers found different alterations of the swallowing mechanism with a NGT in place . In contrast to this, two recent studies, the first dealing with post-acute stroke patients , the second examining a heterogeneous patient collective , did not observe a negative impact of the NGT on the act of swallowing.
According to a recent controlled trial early behavioral swallowing interventions are associated with a more favourable outcome in patients with dysphagic stroke . In the light of this study it is principally desirable to start swallowing treatment with limited oral feeding during therapy even in stroke patients being temporarily fed via a NGT as early as possible.
The question of whether NGTs have an effect, if any, on dysphagia is hence of importance for acute stroke care. Due to the rapidly changing nature of dysphagia during the first two weeks after stroke , the above mentioned study of post-acute stroke patients is not easily extrapolated to the acute stage of the illness. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. In particular, two different topics were addressed. First, we examined how often pharyngeal misplacement of NGTs, in particular coiling of the tube in the pharynx, occurred and whether this led to worsening of dysphagia. Second, the impact of a correctly placed NGT on the swallow was explored.