A Functional Outcome Swallowing Scale for Staging Oropharyngeal Dysphagia

Objective: To develop a simple and straightforward functional outcome swallowing scale (FOSS) for patients with oropharyngeal dysphagia to determine the severity of the disorder and the effectiveness of therapy or outcome. Design: Five years ago, the author developed a dysphagia staging scale based on personal experience and a review of the English literature. This scale was shared with colleagues from the specialties of otolaryngology, speech pathology, neurology, and gastroenterology, both within and outside the author’s institution. Minor modifications have been made. The scale has been used in clinical management and retrospective studies. Setting: Patients were seen in a multispecialty, tertiary care, academic center. Patients: The patient population included the full spectrum of oropharyngeal dysphagia in adults, but was weighted heavily toward aging patients and patients with head and neck cancer, neurologic disorders, gastroesophageal conditions, and psychiatric problems. Results: The stages are as follows: stage 0 = normal function and asymptomatic; stage I = normal function but with episodic or daily symptoms of dysphagia; stage II = compensated abnormal function manifested by significant dietary modifications or prolonged mealtime (without weight loss or aspiration); stage III = decompensated abnormal function with weight loss of 10% or less of body weight over 6 months due to dysphagia, or daily cough, gagging, or aspiration during meals; stage IV = severely decompensated abnormal function with weight loss of more than 10% of body weight over 6 months due to dysphagia, or severe aspiration with bronchopulmonary complications, nonoral feeding recommended for most of nutrition, and stage V = nonoral feeding for all nutrition. Conclusions: The FOSS was successful for staging various adult patients with dysphagia into clinically useful, overall performance categories. It has been applied successfully to retrospective outcome studies and to clinical management by clinicians from different specialties.