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 * 3-oz Water Test Outline

Define:**
 * 3oz water swallow test is a widely used method of screening individuals who are at risk for oropharyngeal dysphagia and aspiration (2008)
 * Individuals are required to drink 3oz of water without interruption (2008)
 * Criteria for referral for further assessment of swallowing include inability to complete the task, coughing, choking, or a wet-hoarse vocal quality exhibited either during or within 1 minute of test completion (2008)
 * Demonstration


 * History:**
 * First published methods of 3 Oz-water test- DePippo in 1992 (ASHA Leader, 2009) (DePippo, 1992)


 * Pros:**
 * Quick, easy, and doesn't require purchase of expensive machines or other materials (find citation to support this)
 * Good screening tool for children with suspected dysphagia (Suiter, Leder, & Karas, 2009)
 * Help avoid unnecessary exposure to radiation
 * Pass Screen - Diet recommendations without VFSS
 * Fail Screen - Referred for instrumental evaluation
 * Sensitivity - 100% of children who were aspirating failed the 3-oz. water screen
 * Results indicated that the 3oz water swallow test was sensitive for determining aspiration of thin liquids (2008)
 * The 3oz water test had a high negative predictive value (97.9%), indicating that most individuals who passed the water swallow test, i.e., had a negative response, also did not aspirate during instrumental examination (2008)


 * Cons:**
 * In the study on children with suspected dysphagia, 61.8% of patents who failed the 3-oz. water test did not aspirate during the instrumental evaluation using a FEES (Suiter, Leder, & Karas, 2009). Specificity was low and the false positive rate was high.
 * Specificity - 52.3 %
 * False Positive - 48.8%
 * Specificity for determining liquid aspiration during instrumental assessment was low, 48.7%, and the false-positive rate was high, 49.7%. (2008)
 * The combination of low specificity with a high false-positive rate for aspiration status on the 3oz water swallow test compared with FEES would result in approximately half of patients screened being referred unnecessarily for further swallow evaluation. (2008)
 * Because one of the purposes of a screening test is to reliably and effectively determine the need for a formal swallow evaluation, the 3oz water swallow test **fails** because it over-refers for formal swallow assessment and unnecessarily restricts liquid intake for nearly half of the patients tested (2008)

· If the test is passed, not only thin liquids but other food consistencies can be recommended confidently and without further instrumental dysphagia (2008) · A caveat of the 3oz water swallow test is that due to a high false-positive rate and low specificity, it is not an efficient screening tool for identification of individuals who are at risk for aspiration of thin liquids (2008) -However, over-referral for an instrumental evaluation, although conservative, is not in and of itself a negative because it allows for greater objective identification of aspiration and the potential to determine diet recommendations and therapeutic strategies to promote resumption of safe oral alimentation (2008)
 * Conclusion:**


 * Questionable Research Methods:**
 * In the Suiter, Leder, & Karas (2009) study on children with suspected dysphagia, the FEES was performed prior to the 3-oz. water test and by the same examiner. The results of the FEES could have impacted the interpretation of the 3-oz. water test.

Suiter, D. M., Leder, S. B., & Karas, D. E. (2009). The 3-ounce (90-cc) water swallow challenge: A screening test for children with suspected oropharyngeal dysphagia. //Otolaryngology - Head and Neck surgery//, 140, 187-190.**
 * References:

Suiter, D. M., & Leder, S. B. (2008) Clinical utility of the 3-ounce water swallow test. //Dysphagia,// 23, 244-250.

DePippo, K.L., Holas, M.A., & Reding, M.J. (1992). Validation of the 3-oz water swallow test for aspiration following stroke. //Arch Neurology//, 49, 1259-1261.