The Role of Cough Reflex Testing in Detecting Silent Aspiration Risk with Dr Phoebe Macrae

<p>In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Phoebe Macrae from the University of Canterbury to unpack the evidence on cough reflex testing: what it tells us, what it doesn&#39;t, and whether clinicians are making a dangerous assumption when Cough Reflex Testing (CRT) results aren&#39;t available.</p><p> </p><p>In this episode we cover:</p><p> </p><ul><li>What cough reflex testing is and how it works as a screening tool for silent aspiration risk</li><li>The key finding from Phoebe&#39;s research: a failed CRT leads to significantly more restrictive management, but in the absence of any CRT result, clinicians manage patients almost identically to those who passed</li><li>What that pattern reveals about our default assumptions around airway sensation</li><li>How aspiration pneumonia risk factors influenced clinician decision-making in the study</li><li>The sensitivity and specificity of CRT and why it&#39;s not a perfect predictor of aspiration</li><li>The complexity of interpreting CRT results across different textures — including patients who silently aspirate on thickened fluids after overtly aspirating on thin</li><li>Why Phoebe frames CRT as one piece of a bigger clinical picture, not a standalone decision-making tool</li><li>What Phoebe would want her own caregivers to know if she ever developed dysphagia</li></ul><p> </p><p>The publication this episode is based on:</p><p>Darrock, K., Wallace, E., Guiu Hernandez, E., Huckabee, M.-L., Mills, M., &amp; Macrae, P. (2024). The influence of cough reflex testing on patient management. <em>Journal of Speech, Language, and Hearing Research, 67</em>, 2987–2996. <a href="https://doi.org/10.1044/2024_JSLHR-24-00174">https://doi.org/10.1044/2024_JSLHR-24-00174</a></p><p> </p><p>Other articles mentioned:</p><p> </p><p>Miles A, Zeng IS, McLauchlan H, Huckabee ML. Cough reflex testing in Dysphagia following stroke: a randomized controlled trial. J Clin Med Res. 2013 Jun;5(3):222-33. doi: 10.4021/jocmr1340w. Epub 2013 Apr 23. PMID: 23671548; PMCID: PMC3651073. <a href="https://pubmed.ncbi.nlm.nih.gov/23671548/">https://pubmed.ncbi.nlm.nih.gov/23671548/</a></p><p> </p><p>Miles A, Moore S, McFarlane M, Lee F, Allen J, Huckabee ML. Comparison of cough reflex test against instrumental assessment of aspiration. Physiol Behav. 2013 Jun 13;118:25-31. doi: 10.1016/j.physbeh.2013.05.004. Epub 2013 May 12. PMID: 23672854. <a href="https://pubmed.ncbi.nlm.nih.gov/23672854/">https://pubmed.ncbi.nlm.nih.gov/23672854/</a></p><p> </p><p>For clinical resources and evidence-based dysphagia education beyond the podcast, head to: <a href="http://www.dysphagiabites.com/">www.dysphagiabites.com</a></p><p><br></p>