Table 1 Hyodo–komagane scoring rubric.

From: Impact of severe dysphagia on overall survival after percutaneous endoscopic gastrostomy

A: Salivary pooling in vallecula and piriform sinuses

0　　No pooling

1　　Pooling only at the vallecula

2　　Pooling in vallecula and piriform sinuses and no penetration1 into larynx

3　　Pooling in vallecula and piriform sinuses and penetration into larynx

B: The response of glottal closure reflex induced by touching the epiglottis with the endoscope

0　　Marked reflex by one touching

1　　Slow and/or weak reflex by one touching

2　　Reflex by two or three touchings

3　　No reflex despite three touchings

C: The location of the bolus at the time of swallow onset assessed by “white-out"2 following swallowing of test jelly

0　　Pharyngeal

1　　Vallecula

2　　Piriform sinuses

3　　No swallowing

D: The extent of pharyngeal clearance after swallowing of test jelly

0　　No residues

1　　Pharyngeal residues remain, but are absent after swallowing is attempted two or three times

2　　Pharyngeal residues remain, but do not penetrate into larynx

3　　Pharyngeal residues remain and penetrate into larynx

  1. 1　When saliva or test jelly enters the glottis (opening to the trachea) and moves as far as the vestibule above the true vocal folds, this is termed as “penetration”.
  2. 2　“White-out” is defined as the period when the videoendoscopic image is obscured owing to pharyngeal closure.
  3. Total score = (A + B + C + D) = 0–12.
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