Supplementary Material for: Swallowing Impairment in Amyloidosis: A Study of Objective and Subjective Dysphagia Measures

Background: Systemic amyloidosis, a rare disorder characterized by protein accumulation, affects various organs and can impair swallowing, leading to complications like aspiration pneumonia. This study aimed to measure swallowing function in patients with systemic amyloidosis using both objective and subjective methods of assessment to determine the specific stages and severity of dysphagia. Methods: Twenty-six patients with amyloidosis underwent a prospective evaluation using flexible endoscopic evaluation of swallowing (FEES) and the Eating Assessment Tool (EAT-10). The measures included the Penetration-Aspiration Scale (PAS), Yale Pharyngeal Residue Severity Scale (YPRSS), Functional Oral Intake Scale (FOIS), and Functional Oral Swallowing Scale (FOSS). Swallowing impairments were determined in relation to the established normal reference values for each assessment. Results: The average EAT-10 score exceeded normal population levels, reflecting higher perceived swallowing difficulties. FEES assessments revealed elevated risk of penetration and aspiration, especially with liquids (PAS: p<0.001), and significant pharyngeal residue (YPRSS: p<0.001). FOSS scores also indicated reduced swallowing efficiency compared with controls (p<0.001). Conclusion: Patients with amyloidosis experience substantial swallowing impairment, particularly with fluid intake, increasing their risk for aspiration. The combined use of FEES and EAT-10 provides a comprehensive assessment approach, supporting the need for targeted dietary strategies and careful dysphagia management in these patients.