Correlation between the Murray Secretion Scale and the Yale Pharyngeal Residue Severity Rating Scale

Filipa Ferreira, Paula Correia, Sílvia Alves, Mariana Branco, Mariana Neto, Luis Antunes


Introduction: The Murray Secretion Scale (MSS) is a validated instrument for the assessment of the accumulation of secretions and can be used during any fiberoptic nasopharyngoscopy (FNP) by the general otorhinolaryngologist. The Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) was developed for the determination of pharyngeal residue after swallowing and is used during the formal swallowing assessment consultation.

Objectives: To compare the correlation between MSS and YPRSRS both in ENT professionals with and without experience in deglutition evaluation.

Material and Methods: 40 flexible endoscopic evaluation of swallowing (FEES) were selected from a retrospective cohort. The evaluation was carried out by 8 different clinicians, 2 of them experienced in deglutition. All exams were graded according to the degree of severity using the two scales.

Results: There was a strong correlation between the assessments of each observer on both scales (Τβ between 0.327 p=0.014 and 0.598 p=0.001). The inter-observer correlation was higher the more experienced the judges were: κ=0.369 (95% CI, 0.366 to 0.373), p=0,001 vs κ=0832(95% CI 0.827 to 0.838), p=0,001 for MSS and κ=0.305 (95% CI, 0.302 to 0.308), p=0,001 vs κ=0.678 (95% CI,0.673 to 0.684) p=0,001 for YPRSRS.

Conclusion: There was a significant correlation between the classification on the MSS and the YPRSRS in observers with and without experience. Presence of salivary stasis in the FNP may alert the general ENT to the potential risk of pharyngeal residue after swallowing and to the need to referral to a swallowing assessment.

Palabras clave

dysphagia; swallowing; endoscopy

Texto completo:



Kuo CW, Allen CT, Huang CC, Lee CJ. Murray secretion scale and fiberoptic endoscopic evaluation of swallowing in predicting aspiration in dysphagic patients. Eur Arch Otorhinolaryngol. 2017;274(6):2513-9. DOI: 10.1007/s00405-017-4522-y

Alsaied AS, Postma GN. In-Office Evaluation and Management of Dysphagia. Otolaryngol Clin North Am. 2019;52(3):577-87. DOI: 10.1016/j.otc.2019.02.007

Speyer R, Cordier R, Farneti D, Nascimento W, Pilz W, Verin E, et al. White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults. Dysphagia. 2022;37(2):333-49. DOI: 10.1007/s00455-021-10283-7

Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11(2):99-103. DOI: 10.1007/BF00417898

Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residue Severity Rating Scale: An Anatomically Defined and Image-Based Tool. Dysphagia. 2015;30(5):521-8. DOI: 10.1007/s00455-015-9631-4

De Vet H, Terwee, C., Mokkink, L., & Knol, D. Measurement in Medicine: A Practical Guide (Practical Guides to Biostatistics and Epidemiology). Cambridge: Cambridge University Press; 2011.

Botsch RE. Chapter 12. Significance and Measures of Association 2011 [updated 11/8/2011. Available from:

Pluschinski P, Zaretsky E, Stöver T, Murray J, Sader R, Hey C. Validation of the secretion severity rating scale. Eur Arch Otorhinolaryngol. 2016;273(10):3215-8. DOI: 10.1007/s00405-016-4073-7

Hey C, Pluschinski P, Stöver T, Zaretsky Y. [Validation of the German short version of the Murray Secretion Rating Scale]. Laryngorhinootologie. 2015;94(3):169-72. DOI: 10.1055/s-0034-1385848

Gerschke M, Schöttker-Königer T, Förster A, Netzebandt JF, Beushausen UM. Validation of the German Version of the Yale Pharyngeal Residue Severity Rating Scale. Dysphagia. 2019;34(3):308-14. DOI: 10.1007/s00455-018-9935-2

Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front Public Health. 2018;6:149. DOI: 10.3389/fpubh.2018.00149

Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing. Dysphagia. 2019;34(4):548-55. DOI: 10.1007/s00455-019-10001-4

Donzelli J, Brady S, Wesling M, Craney M. Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow. Ann Otol Rhinol Laryngol. 2003;112(5):469-75. DOI: 10.1177/000348940311200515

Enlaces refback

  • No hay ningún enlace refback.