Diagnostic accuracy of the gugging swallowing screen (GUSS) in detecting aspiration and dysphagia in patients with unilateral vocal fold paralysis

Abstract

Purpose In 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 Gug ging Swallowing Screen (GUSS) in detecting oropharyngeal dysphagia, penetration, and aspiration in patients with UVFP. Methods A prospective clinical study was conducted involving 31 patients diagnosed with UVFP. All participants under went 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. Results FEES 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 speci ficity 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). Conclusion These 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 facili tate diagnostic screening and referral, ultimately improving dysphagia management in this high-risk population.