Skip to main content Accessibility help

Dysphagia characteristics in Huntington’s disease patients: insights from the Fiberoptic Endoscopic Evaluation of Swallowing and the Swallowing Disturbances Questionnaire

  • Yael Manor (a1) (a2), Yael Oestreicher-Kedem (a3), Alona Gad (a1), Jennifer Zitser (a1), Achinoam Faust-Socher (a1), Dina Shpunt (a1), Stav Naor (a1), Noit Inbar (a1), Meir Kestenbaum (a1), Nir Giladi (a1) and Tanya Gurevich (a1)...



Huntington’s disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined.


To characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients’ self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL).


A retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington’s Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire.


Fourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score.


HD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.


Corresponding author

*Address for correspondence: Yael Manor, PhD, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel. (Email:


Hide All

This author contributed equally to this article.



Hide All
1.Ross, CA, Tabrizi, SJ. Huntington’s disease: from molecular pathogenesis to clinical treatment. Lancet Neurol. 2011; 10(1): 8398.
2.Heemskerk, A, Roos, RA. Dysphagia in Huntington’s disease: a review. Dysphagia. 2011; 26(1): 6266. Tommaso, M, Nuzzi, A, Dellomonaco, AR, et al. Dysphagia in Huntington’s disease: correlation with clinical features. Eur Neurol. 2015; 74(1–2): 4953.
4.McHorney, CA, Robbins, J, Lomax, K, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002; 17(2): 97114.
5.Manor, Y, Mootanah, R, Freud, D, Giladi, N, Cohen, JT. Video-assisted swallowing therapy for patients with Parkinson’s disease. Parkinsonism Relat Disord. 2013; 19(2): 207211.
6.Manor, Y, Giladi, N, Cohen, A, Fliss, DM, Cohen, JT. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson’s disease. Mov Disord. 2007; 22(13): 19171921.
7.Fletcher, SG. Time-by-count measurement of diadochokinetic syllable rate. J Speech Hear Res. 1972; 15(4): 763770.
8.Kremer, HPH. Huntington Unified Huntington's Disease Rating Scale: reliability and consistency. Huntington Study Group Movement Disorders. 1996; 11(2): 136142.
9.Nasreddine, Z. MoCA Version August 18, 2010.
10.Icht, M, Ben-David, BM. Oral-diadochokinesis rates across languages: English and Hebrew norms. J Commun Disord. 2014; 48: 2737.
11.Wallerstein, SL. Scaling clinical pain and pain relief. In: Bromm B, ed. Pain Measurement in Man: Neurophysiological Correlates of Pain. New York: Elsevier; 1984.
12.Kagel, MC, Leopold, NA. Dysphagia in Huntington’s disease: a 16-year retrospective. Dysphagia. 1992; 7(2): 106114.
13.Lee, TH, Lee, JS, Kim, WJ. High resolution impedance manometric findings in dysphagia of Huntington’s disease. World J Gastroentrol. 2012; 18(14): 16951699.
14.Atkinson, M, McHanwell, S. Basic Medical Science for Speech & Language Therapy Students. London: Whurr Publishers; 2002.
15.Van Lieshout, PH, Steele, CM, Lang, AE. Tongue control for swallowing in Parkinson’s disease: effects of age, rate, and stimulus consistency. Mov Disord. 2011; 26(9): 17251729.
16.Alves, TC, Cola, PC, Santos, RR, Motonaga, SM, Silva, RG. Swallowing endoscopy findings in Huntington’s disease: a case report. CoDAS. 2016; 28(4): 486488.
17.Hamakawa, S, Koda, C, Umeno, H, et al. Oropharyngeal dysphagia in a case of Huntiongton’s disease. Auris Nasus Larynx. 2004; 31(2): 171176.
18.Langmore, S. Endoscopic Evaluation and Treatment of Swallowing Disorders. New York: Thieme; 2001.
19.Leder, SB, Cohn, SM, Moller, BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998; 13(4): 208212.
20.Wu, C, Ko, J, Hsiao, T, Hsu, M. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol. 2000; 109(3): 320325.
21.Hartley, BE, Harnick, CJ, Miller, C, Willging, JP. Pediatric fiberoptic endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2000; 109(11): 996999.
22.Stringer, S. Managing dysphagia in palliative care. Prof Nurse. 1999; 14(7): 489492.
23.Rosenblatt, A, Ranen, N, Nance, M, Paulsen, J. A Physician’s Guide to the Management of Huntington’s Disease. 2nd ed. New York: HDSA; 1999.
24.Aziz, NA, van der Marck, MA, Pijl, H, et al. Weight loss in neurodegenerative disorders. J Neurol. 2008; 255(12): 18721880.
25.Van Liew, C, Gluhm, S, Goldstein, J, Cronan, TA, Corey-Bloom, J. The functional implications of motor, cognitive, psychiatric, and social problem-solving states in Huntington’s disease. Psychiatry. 2013; 76(4): 323335.
26.Saldert, C, Fors, A, Ströberg, S, Hartelius, L. Comprehension of complex discourse in different stages of Huntington’s disease. Int J Lang Commun Disord. 2010; 45(6): 656669.
27.Baker, M, Blumlein, D. Huntington’s disease part I: what is it? British Journal of Healthcare Assistants. 2009; 3(5): 223227.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed