The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury

The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury Hai Fei, Xing-Ming Zhong, Yong Cai, Li-Ying Dong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8225684/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose The aim of this study was to explore the value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury. Methods The role of BAEP in the diagnosis of dysphagia was studied by retrospectively analyzing the results of BAEP examination and the gold standard diagnosis of dysphagia in 106 patients with head injury.Inclusion criteria: ①Age 18 ~ 70 years old; ② Diagnosed by Chinese Expert Consensus on Evaluation and Treatment of Dysphagia. Exclusion criteria: ① Patients with a Glasgow coma scale score ≤ 8 and patients who cannot be managed with intervention; ② Previous comorbidities that may affect swallowing function. Results A total of 65 males and 41 females patients were enrolled. The positive rate of BAEP in moderate to severe dysphagia was 86.96%, which was significantly higher than that in the mild dysphagia group (45.95%) (P < 0.01). 60 patients were BAEP-positive and moderate-to-severe dysphagia patients, and considered neurogenic dysphagia, 46 patients were BAEP-negative, and considered non-neurophagia. The AUC of BAEP diagnosis of moderate to severe dysphagia was 0.705. Conclusion BAEP can be used as an accurate diagnostic method for nerve injury, it is helpful to identify whether it is a neurological dysphagia. Health sciences/Diseases Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience Brainstem auditory evoked potential(BAEP) Craniocerebral injury Dysphagia Figures Figure 1 Introduction With the development of emergency medicine and critical care medicine, the survival rate of patients with craniocerebral injuries has been substantially improved, but along with it, the disability rate of patients is also increasing year by year [1] . According to statistics, nearly 30%~73% of patients with craniocerebral injuries will suffer from neurogenic swallowing dysfunction, which will lead to serious consequences such as aspiration pneumonia, dehydration, hypoproteinemia, and so on, of which aspiration pneumonia is even more related to the prognosis of the patients, and may even lead to an increase in the rate of death [2, 3] . Post-traumatic dysphagia can be categorized into structural dysphagia and neurological dysphagia (ND) according to the pathogenesis [4] . The main causes of the former include inflammation, injury, or tumor of the swallowing passage or adjacent organs, which usually results in better functional recovery after symptomatic treatment. In contrast, neurological dysphagia tends to have a poorer prognosis and currently lacks effective rehabilitative treatments, which should be targeted as early as possible to minimize functional loss [5] . When dealing with patients with post-traumatic dysphagia, it is necessary to distinguish between neurologic and structural dysphagia. Currently, the diagnosis of neurogenic dysphagia is mostly based on clinical symptoms, and relevant auxiliary tests such as the puddle-drinking test, GUSS Scores can only provide indirect evidence of neurologic injury, and these tests cannot effectively differentiate between neurologic and non-neurologic injury-induced dysphagia. Therefore, the difficulty in diagnosing dysphagia often delays the treatment of aspiration pneumonia, and the search for an early and effective adjunctive test for the early diagnosis of dysphagia is urgent and necessary [4] . Brainstem auditory evoked potential (BAEP), also known as auditory brainstem response ( ABR ), is a series of neurogenic electrical activities induced by acoustic stimulation with a latency of less than 10 milliseconds. Since the amplitude of neuronal activity induced by a single stimulation is only 1/100 of the amplitude of normal brain wave, a clear waveform can be obtained by computer superposition [6] . BAEP has become a commonly used neurophysiological detection technique in clinical practice, and the technique is extremely sensitive to neurophysiology, and abnormal changes can be seen even when there is a mild brainstem injury presenting with no obvious clinical signs and symptoms [7, 8] . In previous studies, BAEP has shown good diagnostic value in the detection of abnormal swallowing function in groups such as postoperative patients with hemifacial spasm (HFS) and patients with spinocerebellar ataxia [9, 10] . However, the early diagnostic value of BAEP for swallowing disorders in patients with craniocerebral injuries has not been confirmed by effective studies. Methods Study participants Patients with dysphagia after craniocerebral injury who were admitted to the Department of Neurosurgery were selected for this study. Inclusion criteria: (1)Age 18~70 years old; (2) Diagnosed by Chinese Expert Consensus on Evaluation and Treatment of Dysphagia [11] . Exclusion criteria: (1) patients with a Glasgow coma scale score ≤8, as such patients are admitted to the ICU due to the severity of their injuries; (2)patients with other critical illnesses who could not cooperate with the intervention; (3) previous swallowing dysfunction or concurrent comorbidities that may affect swallowing function; (4) concurrently participating in other studies.This study has been registered in the Chinese Clinical Data Center with the registration number of ChiCTR2500104698. Evaluation of dysphagia and related ancillary examination GUSS Scores was a clinical test of swallowing liquids, pastes, and solids, with the next food being swallowed only after completion of the previous one, thus reducing the risk of patient aspiration and improving safety, which can be used to screen patients at high risk for swallowing dysfunction in craniocerebral injury [12, 13] . The scale determines dysphagia based on a score of 0-19, where 0-9, 10-14, and 15-19 correspond to severe, moderate, and mild dysphagia in that order, and 20 is the presence of no dysphagia. The NIHSS score was used to evaluate the severity of neurological deficits [14] . The scale includes 11 items and 15 items, including consciousness, gaze, facial paralysis, upper limb muscle strength, lower limb muscle strength, ataxia, aphasia, sensory, visual field, neglect syndrome, and distal limb function, with a total score of 0~42 points, the higher the score, the more serious the neurological deficit. BAEP test All patients underwent bedside BAEP at a random time early in admission (≤ 24 hours) and were performed by formally trained, discipline-compliant technicians. The instrument used was a BAEP module of a Medelec Synergy neuromyography (OXFORD, UK). Keep the room quiet and avoid external interference as much as possible. Before the test, the subject is instructed to relax and rest quietly, and ask him to put his hands at his sides, wipe with alcohol, and let them dry. The needle electrode is placed in the median position of the cranial roof, the reference electrode is placed on the donal side of the mastoid, and the contralateral side of the mastoid process is grounded. The stimulus is a short sound with a frequency of 10 beats/s and an intensity of 60 dBnHL. The filtering parameters were 30~3000 Hz, and the sampling time was 10 ms. The amplitude is directly read out by the tester, and the latency, inter-wave interval and waveform of waves I., III, V. of the BAEP examination chart are recorded. Each check is repeated at least 2 times and averaged to ensure repeatability of waves I., III., V [7] . Statistical analysis All data were collected using Excel and accurately entered into SPSS 26.0 software for statistical analysis. Continuous data (age, GCS Scores, GUSS Scores, NIHSS Scores, etc.) were expressed as mean ± SD; whereas categorical data like gender, site of injury, cause of injury, etc. were expressed as frequency and percentage. Chi-square test was used to analyze the relationship between the degree of dysphagia and the abnormal rate of BAEP test, and the ROC curve of BAEP in diagnosing the degree of dysphagia was plotted. Ethical approval This study has been reviewed and approved by the hospital's ethical review committee (approval No.2023KYLL052), and all patients participating in this study signed an informed consent form. Results General information and grouping From January 2018 to December 2020, a total of 106 patients who met the diagnosis of craniocerebral injury were included in this study, including 65 males and 41 females, with an average age of (42.980±13.01) years, including 38 traffic accident injuries, 34 fall injuries from heights, 29 self-inflicted falls, 5 falling objects. Some patients had impaired consciousness on admission, but had recovered to the point where they were able to cooperate in completing the assessment at the time of diagnosis of dysphagia. Detailed basic information is shown in Table 1. Table 1 Inclusion of demographic and clinical characteristics of included patients. Variables Total (n=106) Age (years, x±s) 42.980±13.01 Gender (%) Male 65 (61.32%) Female 41 (38.68%) Causes of injury (%) traffic accidents 38 (35.85%) falls from heights 34 (32.06%) self-inflicted falls 29 (27.36%) falling objects 5 (4.72%) Sites of injury (%) frontal 13 (12.26%) temporal 14 (13.21%) parietal 15 (14.15%) occipital 12 (11.32%) thalamus 13 (12.26%) cerebellum 16 (15.09%) basal ganglia 10 (9.43%) 2 or more sites 13 (12.26%) GCS (points, x±s) 10.80±1.934 GUSS (points, x±s) 13.10±2.828 NIHSS (points, x±s) 15.43±4.045 Table1 presents the detailed demographic and clinical characteristics of the 106 patients included in the study. The table includes information on age, gender, causes of injury, sites of injury, Glasgow Coma Scale (GCS) score, Gugging Swallowing Screen (GUSS) score, and National Institutes of Health Stroke Scale (NIHSS) score. Evaluation of swallowing function and neurologic deficits All 106 patients were evaluated for swallowing function and nerve damage within 1 week of admission. According to the results of GUSS assessment of dysphagia: the number of cases of mild, moderate, and severe dysphagia were 37 (34.91%), 57 (53.77%), and 12 (11.32%), respectively. Secondly, according to the NIHSS assessment: the number of cases of moderate, moderately severe, and severe neurological damage were 64 (60.38%), 26 (24.53%), and 16 (15.10%), respectively. BAEP test There were 77 cases with abnormal BAEP test results (72.64% positive rate). I-wave latency and wave amplitude were abnormal in 77 abnormal cases, of which 20 (25.97%) had abnormal III-wave latency and wave amplitude and 16 (19.48%) had abnormal V-wave latency and wave amplitude. According to the degree of dysphagia, the positive rate of BAEP detection and the distribution of abnormal waveforms in the three groups were analyzed. The BAEP positivity rate was the highest in the moderate dysphagia group, which was 92.98%. There was a statistically significant difference in the positive rate of BAEP between the three groups (P＜0.01), Table 2. Table 2 The results of BAEP detection and GUSS grade were analyzed in 106 patients. BAEP test GUSS Severity Mild (n=37) Moderate (n=57) Severe (n=12) Total(n=106) χ 2 P BAEP positive 17 53 7 77 (72.64%) 26.371 ＜0.01 I-wave positive 17 53 7 77 (72.64%) 26.371 ＜0.01 III-wave positive 2 14 4 20 (18.87%) 7.228 0.027 V-wave positive 1 11 4 16 (15.09%) 8.334 0.015 Table2 analyzes the relationship between brainstem auditory evoked potential (BAEP) test results and the severity of dysphagia as assessed by the Gugging Swallowing Screen (GUSS) in 106 patients. The table categorizes patients into groups based on the severity of dysphagia (mild, moderate, severe) and presents the BAEP positivity rates along with abnormalities in wave I, III, and V. Additionally, the table provides chi-square test results and p-values to assess the statistical significance of the differences in BAEP positivity rates across different dysphagia severity groups. According to the above results, a four-panel table is plotted, and the ROC curve is plotted. The sensitivity was 86.96% (60/69), the specificity was 54.05%, and the area under the ROC curve was 0.705, Figure 1. Fugure1 ROC curve of BAEP in diagnosing the degree of dysphagia. Figure 1 shows the receiver operating characteristic (ROC) curve of brainstem auditory evoked potentials (BAEP) in diagnosing the degree of dysphagia. The sensitivity was 86.96% (60/69), the specificity was 54.05% (20/37), and the area under the ROC curve (AUC) was 0.705. This figure illustrates the diagnostic accuracy of BAEP in identifying moderate to severe dysphagia. Discussion The innervation of swallowing function is mainly composed of three parts: the swallowing center in the cerebral cortex, the nerve conduction centers in the brainstem, and the peripheral nerves (glossopharyngeal nerve, hypoglossal nerve, vagus nerve, etc) [15] . Neurogenic dysphagia is caused by damage to one or more nerves innervating the completion of the swallowing maneuver due to direct or indirect causes [16] . The results of this study suggest that BAEP testing may be helpful in the diagnosis of neurogenic dysphagia after head injury, and also provide a new diagnostic strategy for screening patients at high risk of dysphagia. Patients with severe brain injury may have damage in the cortical area, brainstem, and peripheral nerves, and some patients may present not only with motor dysfunction, but also with initiation difficulties and cognitive impairment, so they often manifest as multi-site-related dysphagia [17] ; In addition, traditional subjective assessments, such as the GUSS scale, may be biased, and simple bedside assessments alone cannot meet the complexity of the diagnostic and therapeutic needs of swallowing dysfunction. In this study, the causes of dysphagia in 106 patients were divided into neurogenic and non-neurological injuries by BAEP detection. There were 60 patients with BAEP-positive and moderate to severe dysphagia assessed by GUSS, which was considered neurogenic dysphagia. There were 29 patients with a negative BAEP, and dysphagia in these patients may be due to non-neurological causes, such as anatomical position changes, as there is a lack of clear evidence of neuroelectrophysiological impairment. 17 patients were assessed for mild dysphagia with GUSS but positive for BAEP, which may be associated with nerve concussion [7, 18] . Because the prognosis of neurogenic dysphagia differs from that of non-neurogenic dysphagia, it is important to determine the cause of dysphagia. At present, post-traumatic dysphagia is only assessed by subjective scales, and most patients cannot cooperate with esophageography, which makes it difficult to diagnose dysphagia early. BAEP is sensitive to detect the presence of nerve damage, responds reliably, and is rarely disturbed by external interference. In this study, it was found that among 106 patients with dysphagia, the positive rate of BAEP was 72.64% (77/106), of which abnormal I wave was the most common. BAEP has shown good diagnostic value in the diagnosis of neurogenic dysphagia after head injury. Taking GUSS moderate to severe as the gold standard and BAEP positive as the test to be evaluated, the ROC curve was plotted, and the sensitivity was 86.96% (60/69), the specificity was 54.05% (20/37), and the area under the ROC curve was 0.705. These results indicate that BAEP has some accuracy in diagnosing dysphagia. When the patient is unable to cooperate with swallowing function, BAEP is a valuable adjunct to evaluate swallowing function. In summary, BAEP has direct reference value for the diagnosis, treatment and prognosis of dysphagia after head injury, and can be used as an important indicator for clinical evaluation. Limitation The follow-up time of this study was short, and the long-term recovery of swallowing function was not followed up in the long term. Furthermore, patients with craniocerebral injury complicated with dysphagia in only one general hospital were selected as the study population, which was a single-center study, and there may be bias in sample inclusion, which may have a certain impact on the results of this study. Declarations Funding This study was supported by the Basic Public Welfare Research Program of Zhejiang Province (No.LGF21H090001) and the Science and Technology Program of Medicine and Health of Zhejiang Province (No.2023KY319). Ethical statement This study has been reviewed by the Ethics Review Committee of Huzhou First People's Hospital (approval No. 2023KYLL052), and has not adversely affected the rights or interests of patients, nor disclosed the privacy and identity information of patients.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Declaration of competing interest The authors declared no conflicts of interest. Author contributions Zhen-Hai Fei and Xiao-Yang Zhou designed this study and prepared the draft. Yi-Qi Wang and Jian-Guo Yang carried out the clinical diagnosis and treatment of the collected cases. Xing-Ming Zhong, Yong Cai and Li-Ying Dong was responsible for the collection and arrangement of medical records. Hua Gu and Zhao-Hui Zhao performed statistical analysis on the data. Data Availability Statement The datasets used and/or analysed during the current study available from thecorresponding author on reasonable request. References Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 27;130(4):1080-97. Velayutham P, Irace AL, Kawai K, Dodrill P, Perez J, Londahl M, Mundy L, Dombrowski ND, Rahbar R. Silent aspiration: Who is at risk? Laryngoscope. 2018 Aug;128(8):1952-1957. doi: 10.1002/lary.27070. Epub 2017 Dec 27. Middleton S, Rowley J, Hillege S, Hill K, Churilov L, Allnutt N. Clinical guidelines for acute stroke management: which recommendations should remain consensus-based? J Vasc Nurs. 2013 Jun;31(2):72-83. doi: 10.1016/j.jvn.2012.10.001. PMID: 23683766. Dziewas R, Allescher H D, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, et al. 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Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurgery. 2020 Sep 1;87(3):427-434. doi: 10.1093/neuros/nyaa278. PMID: 32761068; PMCID: PMC7426189. Alhashemi HH. Dysphagia in severe traumatic brain injury. Neurosciences (Riyadh). 2010 Oct;15(4):231-6. PMID: 20956918. Pamuk AE, Pamuk G, Bajin MD, Yildiz FG, Sennaroğlu L. Traumatic Facial and Vestibulocochlear Nerve Injury in The Internal Acoustic Canal in The Absence of A Temporal Bone Fracture. J Int Adv Otol. 2018 Aug;14(2):330-333. doi: 10.5152/iao.2018.4782. PMID: 30256206; PMCID: PMC6354463. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8225684","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":624324191,"identity":"644ebbff-dbdb-4a0a-84d9-3bb30b6f7988","order_by":0,"name":"Hai Fei","email":"","orcid":"","institution":"First affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Hai","middleName":"","lastName":"Fei","suffix":""},{"id":624324192,"identity":"fe9b82ac-22bd-4b3e-a7b8-648133626ab3","order_by":1,"name":"Xing-Ming Zhong","email":"","orcid":"","institution":"First affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xing-Ming","middleName":"","lastName":"Zhong","suffix":""},{"id":624324193,"identity":"06618d65-325d-4c69-8fe0-9321cbdbf23f","order_by":2,"name":"Yong Cai","email":"","orcid":"","institution":"First affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Cai","suffix":""},{"id":624324195,"identity":"8afa1a30-c328-40a5-ade4-51d1d0a47671","order_by":3,"name":"Li-Ying Dong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBAC+2b2gw8SKhiYDUA8HmK0GLD3JBs8OEOSFp4DZpIP24AMorWYSyQkSCTOq2MHMhgfvG1jkDcnpMVyRuIBg8RtbMyWMxKYDee2MRjubCCk50ZCQkLiNh5mgxsJbNK8bQwJBgcIazE4kDhHAqSF/TdRWgzOHDBsSGwwANvCTJQWyfaeZIaEYwnMBmceNkvOOSdhuIGQFn5m9uM/f9TUJRscTz744U2ZjTxhv0BBMgMDYwOQliBSPRDYEa90FIyCUTAKRhwAAFlVP6k7gjD+AAAAAElFTkSuQmCC","orcid":"","institution":"First affiliated Hospital of Huzhou University","correspondingAuthor":true,"prefix":"","firstName":"Li-Ying","middleName":"","lastName":"Dong","suffix":""}],"badges":[],"createdAt":"2025-11-28 02:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8225684/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8225684/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107323390,"identity":"f623c5c2-17fd-4172-97da-5ab652c5c164","added_by":"auto","created_at":"2026-04-20 10:56:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":857423,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of BAEP in diagnosing the degree of dysphagia.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8225684/v1/696bd0a55388a9ce81169418.png"},{"id":107323410,"identity":"ad453875-c076-4d28-8206-ef317bf1b3db","added_by":"auto","created_at":"2026-04-20 10:57:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":252331,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8225684/v1/12256026-f6aa-4f09-ae39-3353009b421e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the development of emergency medicine and critical care medicine, the survival rate of patients with craniocerebral injuries has been substantially improved, but along with it, the disability rate of patients is also increasing year by year\u003csup\u003e[1]\u003c/sup\u003e. According to statistics, nearly 30%~73% of patients with craniocerebral injuries will suffer from neurogenic swallowing dysfunction, which will lead to serious consequences such as aspiration pneumonia, dehydration, hypoproteinemia, and so on, of which aspiration pneumonia is even more related to the prognosis of the patients, and may even lead to an increase in the rate of death\u003csup\u003e[2, 3]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePost-traumatic dysphagia can be categorized into structural dysphagia and neurological dysphagia (ND) according to the pathogenesis\u003csup\u003e[4]\u003c/sup\u003e. The main causes of the former include inflammation, injury, or tumor of the swallowing passage or adjacent organs, which usually results in better functional recovery after symptomatic treatment. In contrast, neurological dysphagia tends to have a poorer prognosis and currently lacks effective rehabilitative treatments, which should be targeted as early as possible to minimize functional loss\u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhen dealing with patients with post-traumatic dysphagia, it is necessary to distinguish between neurologic and structural dysphagia. Currently, the diagnosis of neurogenic dysphagia is mostly based on clinical symptoms, and relevant auxiliary tests such as the puddle-drinking test, GUSS Scores can only provide indirect evidence of neurologic injury, and these tests cannot effectively differentiate between neurologic and non-neurologic injury-induced dysphagia. Therefore, the difficulty in diagnosing dysphagia often delays the treatment of aspiration pneumonia, and the search for an early and effective adjunctive test for the early diagnosis of dysphagia is urgent and necessary\u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBrainstem auditory evoked potential (BAEP), also known as auditory brainstem response ( ABR ), is a series of neurogenic electrical activities induced by acoustic stimulation with a latency of less than 10 milliseconds. Since the amplitude of neuronal activity induced by a single stimulation is only 1/100 of the amplitude of normal brain wave, a clear waveform can be obtained by computer superposition\u003csup\u003e[6]\u003c/sup\u003e. BAEP has become a commonly used neurophysiological detection technique in clinical practice, and the technique is extremely sensitive to neurophysiology, and abnormal changes can be seen even when there is a mild brainstem injury presenting with no obvious clinical signs and symptoms\u003csup\u003e[7, 8]\u003c/sup\u003e. In previous studies, BAEP has shown good diagnostic value in the detection of abnormal swallowing function in groups such as postoperative patients with hemifacial spasm (HFS) and patients with spinocerebellar ataxia\u003csup\u003e[9, 10]\u003c/sup\u003e. However, the early diagnostic value of BAEP for swallowing disorders in patients with craniocerebral injuries has not been confirmed by effective studies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy participants\u003c/p\u003e\n\u003cp\u003ePatients with dysphagia after craniocerebral injury who were admitted to the Department of Neurosurgery were selected for this study. Inclusion criteria: (1)Age 18~70 years old; (2) Diagnosed by Chinese Expert Consensus on Evaluation and Treatment of Dysphagia\u003csup\u003e[11]\u003c/sup\u003e. Exclusion criteria: (1) patients with a Glasgow coma scale score\u0026nbsp;≤8, as such patients are admitted to the ICU due to the severity of their injuries; (2)patients with other critical illnesses who could not cooperate with the intervention; (3) previous swallowing dysfunction or concurrent comorbidities that may affect swallowing function; (4) concurrently participating in other studies.This study has been registered in the Chinese Clinical Data Center with the registration number of ChiCTR2500104698.\u003c/p\u003e\n\u003cp\u003eEvaluation of dysphagia and related ancillary examination\u003c/p\u003e\n\u003cp\u003eGUSS Scores was a clinical test of swallowing liquids, pastes, and solids, with the next food being swallowed only after completion of the previous one, thus reducing the risk of patient aspiration and improving safety, which can be used to screen patients at high risk for swallowing dysfunction in craniocerebral injury\u003csup\u003e[12, 13]\u003c/sup\u003e. The scale determines dysphagia based on a score of 0-19, where 0-9, 10-14, and 15-19 correspond to severe, moderate, and mild dysphagia in that order, and 20 is the presence of no dysphagia. The NIHSS score was used to evaluate the severity of neurological deficits\u003csup\u003e[14]\u003c/sup\u003e. The scale includes 11 items and 15 items, including consciousness, gaze, facial paralysis, upper limb muscle strength, lower limb muscle strength, ataxia, aphasia, sensory, visual field, neglect syndrome, and distal limb function, with a total score of 0~42 points, the higher the score, the more serious the neurological deficit.\u003c/p\u003e\n\u003cp\u003eBAEP test\u003c/p\u003e\n\u003cp\u003eAll patients underwent bedside BAEP at a random time early in admission (≤ 24 hours) and were performed by formally trained, discipline-compliant technicians. The instrument used was a BAEP module of a Medelec Synergy neuromyography (OXFORD, UK). Keep the room quiet and avoid external interference as much as possible. Before the test, the subject is instructed to relax and rest quietly, and ask him to put his hands at his sides, wipe with alcohol, and let them dry. The needle electrode is placed in the median position of the cranial roof, the reference electrode is placed on the donal side of the mastoid, and the contralateral side of the mastoid process is grounded. The stimulus is a short sound with a frequency of 10 beats/s and an intensity of 60 dBnHL. The filtering parameters were 30~3000 Hz, and the sampling time was 10 ms. The amplitude is directly read out by the tester, and the latency, inter-wave interval and waveform of waves I., III, V. of the BAEP examination chart are recorded. Each check is repeated at least 2 times and averaged to ensure repeatability of waves I., III., V\u003csup\u003e[7]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eAll data were collected using Excel and accurately entered into SPSS 26.0 software for statistical analysis. Continuous data (age, GCS Scores, GUSS Scores, NIHSS Scores, etc.) were expressed as mean ± SD; whereas categorical data like gender, site of injury, cause of injury, etc. were expressed as frequency and percentage. Chi-square test was used to analyze the relationship between the degree of dysphagia and the abnormal rate of BAEP test, and the ROC curve of BAEP in diagnosing the degree of dysphagia was plotted.\u003c/p\u003e\n\u003cp\u003eEthical approval\u003c/p\u003e\n\u003cp\u003eThis study has been reviewed and approved by the hospital's ethical review committee (approval No.2023KYLL052), and all patients participating in this study signed an informed consent form.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eGeneral information and grouping\u003c/p\u003e\n\u003cp\u003eFrom January 2018 to December 2020, a total of 106 patients who met the diagnosis of craniocerebral injury were included in this study, including 65 males and 41 females, with an average age of (42.980±13.01) years, including 38 traffic accident injuries, 34 fall injuries from heights, 29 self-inflicted falls, 5 falling objects. Some patients had impaired consciousness on admission, but had recovered to the point where they were able to cooperate in completing the assessment at the time of diagnosis of dysphagia. Detailed basic information is shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 Inclusion of demographic and clinical characteristics of included patients.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal (n=106)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eAge (years, x±s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.980±13.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eGender (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65 (61.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41 (38.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eCauses of injury (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003etraffic accidents\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (35.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003efalls from heights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (32.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eself-inflicted falls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29 (27.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003efalling objects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (4.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\"\u003e\n \u003cp\u003eSites of injury (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efrontal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (12.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003etemporal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (13.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eparietal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (14.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eoccipital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (11.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ethalamus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (12.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ecerebellum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (15.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ebasal ganglia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (9.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2 or more sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (12.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eGCS (points, x±s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.80±1.934\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eGUSS (points, x±s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.10±2.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eNIHSS (points, x±s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.43±4.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable1\u0026nbsp;presents the detailed demographic and clinical characteristics of the 106 patients included in the study. The table includes information on age, gender, causes of injury, sites of injury, Glasgow Coma Scale (GCS) score, Gugging Swallowing Screen (GUSS) score, and National Institutes of Health Stroke Scale (NIHSS) score.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEvaluation of swallowing function and neurologic deficits\u003c/p\u003e\n\u003cp\u003eAll 106 patients were evaluated for swallowing function and nerve damage within 1 week of admission. According to the results of GUSS assessment of dysphagia: the number of cases of mild, moderate, and severe dysphagia were 37 (34.91%), 57 (53.77%), and 12 (11.32%), respectively. Secondly, according to the NIHSS assessment: the number of cases of moderate, moderately severe, and severe neurological damage were 64 (60.38%), 26 (24.53%), and 16 (15.10%), respectively.\u003c/p\u003e\n\u003cp\u003eBAEP test\u003c/p\u003e\n\u003cp\u003eThere were 77 cases with abnormal BAEP test results (72.64% positive rate). I-wave latency and wave amplitude were abnormal in 77 abnormal cases, of which 20 (25.97%) had abnormal III-wave latency and wave amplitude and 16 (19.48%) had abnormal V-wave latency and wave amplitude. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the degree of dysphagia, the positive rate of BAEP detection and the distribution of abnormal waveforms in the three groups were analyzed. The BAEP positivity rate was the highest in the moderate dysphagia group, which was 92.98%. There was a statistically significant difference in the positive rate of BAEP between the three groups (P＜0.01), Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 The results of BAEP detection and GUSS grade were analyzed in 106 patients.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"681\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eBAEP test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003eGUSS Severity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMild (n=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate (n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere (n=12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal(n=106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBAEP positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (72.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eI-wave positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (72.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIII-wave positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (18.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eV-wave positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (15.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable2 analyzes the relationship between brainstem auditory evoked potential (BAEP) test results and the severity of dysphagia as assessed by the Gugging Swallowing Screen (GUSS) in 106 patients. The table categorizes patients into groups based on the severity of dysphagia (mild, moderate, severe) and presents the BAEP positivity rates along with abnormalities in wave I, III, and V. Additionally, the table provides chi-square test results and p-values to assess the statistical significance of the differences in BAEP positivity rates across different dysphagia severity groups.\u003c/p\u003e\n\u003cp\u003eAccording to the above results, a four-panel table is plotted, and the ROC curve is plotted. The sensitivity was 86.96% (60/69), the specificity was 54.05%, and the area under the ROC curve was 0.705, Figure 1.\u003c/p\u003e\n\u003cp\u003eFugure1\u0026nbsp;\u0026nbsp;ROC curve of BAEP in diagnosing the degree of dysphagia.\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the receiver operating characteristic (ROC) curve of brainstem auditory evoked potentials (BAEP) in diagnosing the degree of dysphagia. The sensitivity was 86.96% (60/69), the specificity was 54.05% (20/37), and the area under the ROC curve (AUC) was 0.705. This figure illustrates the diagnostic accuracy of BAEP in identifying moderate to severe dysphagia.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe innervation of swallowing function is mainly composed of three parts: the swallowing center in the cerebral cortex, the nerve conduction centers in the brainstem, and the peripheral nerves (glossopharyngeal nerve, hypoglossal nerve, vagus nerve, etc)\u003csup\u003e[15]\u003c/sup\u003e. Neurogenic dysphagia is caused by damage to one or more nerves innervating the completion of the swallowing maneuver due to direct or indirect causes\u003csup\u003e[16]\u003c/sup\u003e. The results of this study suggest that BAEP testing may be helpful in the diagnosis of neurogenic dysphagia after head injury, and also provide a new diagnostic strategy for screening patients at high risk of dysphagia.\u003c/p\u003e\n\u003cp\u003ePatients with severe brain injury may have damage in the cortical area, brainstem, and peripheral nerves, and some patients may present not only with motor dysfunction, but also with initiation difficulties and cognitive impairment, so they often manifest as multi-site-related dysphagia\u003csup\u003e[17]\u003c/sup\u003e; In addition, traditional subjective assessments, such as the GUSS scale, may be biased, and simple bedside assessments alone cannot meet the complexity of the diagnostic and therapeutic needs of swallowing dysfunction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, the causes of dysphagia in 106 patients were divided into neurogenic and non-neurological injuries by BAEP detection. There were 60 patients with BAEP-positive and moderate to severe dysphagia assessed by GUSS, which was considered neurogenic dysphagia. There were 29 patients with a negative BAEP, and dysphagia in these patients may be due to non-neurological causes, such as anatomical position changes, as there is a lack of clear evidence of neuroelectrophysiological impairment. 17 patients were assessed for mild dysphagia with GUSS but positive for BAEP, which may be associated with nerve concussion\u003csup\u003e[7, 18]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBecause the prognosis of neurogenic dysphagia differs from that of non-neurogenic dysphagia, it is important to determine the cause of dysphagia. At present, post-traumatic dysphagia is only assessed by subjective scales, and most patients cannot cooperate with esophageography, which makes it difficult to diagnose dysphagia early. BAEP is sensitive to detect the presence of nerve damage, responds reliably, and is rarely disturbed by external interference. In this study, it was found that among 106 patients with dysphagia, the positive rate of BAEP was 72.64% (77/106), of which abnormal I wave was the most common.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBAEP has shown good diagnostic value in the diagnosis of neurogenic dysphagia after head injury. Taking GUSS moderate to severe as the gold standard and BAEP positive as the test to be evaluated, the ROC curve was plotted, and the sensitivity was 86.96% (60/69), the specificity was 54.05% (20/37), and the area under the ROC curve was 0.705. These results indicate that BAEP has some accuracy in diagnosing dysphagia. When the patient is unable to cooperate with swallowing function, BAEP is a valuable adjunct to evaluate swallowing function.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn summary, BAEP has direct reference value for the diagnosis, treatment and prognosis of dysphagia after head injury, and can be used as an important indicator for clinical evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe follow-up time of this study was short, and the long-term recovery of swallowing function was not followed up in the long term. Furthermore, patients with craniocerebral injury complicated with dysphagia in only one general hospital were selected as the study population, which was a single-center study, and there may be bias in sample inclusion, which may have a certain impact on the results of this study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Basic Public Welfare Research Program of Zhejiang Province (No.LGF21H090001) and the Science and Technology Program of Medicine and Health of Zhejiang Province (No.2023KY319).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been reviewed by the Ethics Review Committee of Huzhou First People's Hospital (approval No. 2023KYLL052), and has not adversely affected the rights or interests of patients, nor disclosed the privacy and identity information of patients.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhen-Hai Fei and Xiao-Yang Zhou designed this study and prepared the draft. Yi-Qi Wang and Jian-Guo Yang carried out the clinical diagnosis and treatment of the collected cases. Xing-Ming Zhong, Yong Cai and Li-Ying Dong was responsible for the collection and arrangement of medical records. Hua Gu and Zhao-Hui Zhao performed statistical analysis on the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from thecorresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. \u003cem\u003eJ Neurosurg. \u003c/em\u003e2018 Apr 27;130(4):1080-97.\u003c/li\u003e\n\u003cli\u003eVelayutham P, Irace AL, Kawai K, Dodrill P, Perez J, Londahl M, Mundy L, Dombrowski ND, Rahbar R. Silent aspiration: Who is at risk? \u003cem\u003eLaryngoscope. \u003c/em\u003e2018 Aug;128(8):1952-1957. doi: 10.1002/lary.27070. Epub 2017 Dec 27. \u003c/li\u003e\n\u003cli\u003eMiddleton S, Rowley J, Hillege S, Hill K, Churilov L, Allnutt N. Clinical guidelines for acute stroke management: which recommendations should remain consensus-based? \u003cem\u003eJ Vasc Nurs.\u003c/em\u003e 2013 Jun;31(2):72-83. doi: 10.1016/j.jvn.2012.10.001. PMID: 23683766.\u003c/li\u003e\n\u003cli\u003eDziewas R, Allescher H D, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, et al. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology.\u003cem\u003e Neurol Res Pract.\u003c/em\u003e 2021 May 4;3(1):23. DOI: 10.1186/s42466-021-00122-3.\u003c/li\u003e\n\u003cli\u003eChinese Journal of Physical Medicine and Rehabilitation2023，45(12)1057-1072DOI:10.3760/cma.j.issn.0254-1424.2023.12.001\u003c/li\u003e\n\u003cli\u003eY E Shuai, Z Jianhua. Brainstem auditory evoked potentials at high stimulation rates and posterior circulation ischemia[J]. Jo\u003cem\u003eurnal of Apoplexy and Nervous Diseases.\u003c/em\u003e 2023, 40(11): 967-70.\u003c/li\u003e\n\u003cli\u003eGu H, Zhong XM, Wang YQ, Yang JG, Cai Y. Brainstem auditory evoked potential combined with high resolution cranial base CT can optimize the diagnosis of auditory nerve injury. \u003cem\u003eChin J Traumatol.\u003c/em\u003e 2022 May;25(3):156-160. doi: 10.1016/j.cjtee.2021.12.003. Epub 2021 Dec 13.\u003c/li\u003e\n\u003cli\u003eMoreno-Aguirre AJ, Santiago-Rodr\u0026iacute;guez E, Harmony T, Fern\u0026aacute;ndez-Bouzas A, Porras-Kattz E. Analysis of auditory function using brainstem auditory evoked potentials and auditory steady state responses in infants with perinatal brain injury. \u003cem\u003eInt J Audiol.\u003c/em\u003e 2010 Feb;49(2):110-5. \u003c/li\u003e\n\u003cli\u003eFlanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, Petrov D, Lee JYK. Fully endoscopic microvascular decompression for hemifacial spasm. \u003cem\u003eJ Neurosurg.\u003c/em\u003e 2018 Oct 5;131(3):813-819. doi: 10.3171/2018.4.JNS172631. PMID: 30497190.\u003c/li\u003e\n\u003cli\u003eZeigelboim BS, de Carvalho HA, Teive HA, Liberalesso PB, Jurkiewicz AL, da Silva Abdulmassih EM, Marques JM, Cordeiro ML. Central auditory processing in patients with spinocerebellar ataxia. \u003cem\u003eHear Res. \u003c/em\u003e2015 Sep;327:235-44. \u003c/li\u003e\n\u003cli\u003eChinese Journal of Physical Medicine and Rehabilitation2017，39(12)881-892DOI:10.3760/cma.j.issn.0254-1424.2017.12.001\u003c/li\u003e\n\u003cli\u003eTroll C, Trapl-Grundschober M, Teuschl Y, Cerrito A, Compte MG, Siegemund M. A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit - validation of the Gugging Swallowing Screen (GUSS)-ICU.\u003cem\u003e BMC Anesthesiol.\u003c/em\u003e 2023 Apr 13;23(1):122. doi: 10.1186/s12871-023-02072-6. PMID: 37055724; PMCID: PMC10099025.\u003c/li\u003e\n\u003cli\u003eGunes T, Liman E, Bas IP, Soylemez C, Erdal Y, Emre U, Akdeniz E. The simple and fast swallowing function assessment in acute stroke patients.\u003cem\u003e North Clin Istanb. \u003c/em\u003e2020 Jun 2;7(4):391-397. doi: 10.14744/nci.2019.00821. PMID: 33043266; PMCID: PMC7521105.\u003c/li\u003e\n\u003cli\u003eZhou Houshi, Lian Xiaodong, Lin Qi，Zhang Xiongru，Wang Yangyang. Evaluation of brainstem auditory evoked potential (BAEP) in swallowing dysfunction after brain stem infraction[J]. \u003cem\u003eStroke and Nervous Disease.\u003c/em\u003e 2018, 25(01): 17-20.\u003c/li\u003e\n\u003cli\u003eGlass TJ, Kelm-Nelson CA, Szot JC, Lake JM, Connor NP, Ciucci MR. Functional characterization of extrinsic tongue muscles in the Pink1-/- rat model of Parkinson disease. \u003cem\u003ePLoS One. \u003c/em\u003e2020 Oct 16;15(10):e0240366. doi: 10.1371/journal.pone.0240366. PMID: 33064741; PMCID: PMC7567376.\u003c/li\u003e\n\u003cli\u003eHawryluk GWJ, Rubiano AM, Totten AM, O\u0026apos;Reilly C, Ullman JS, Bratton SL, Chesnut R, Harris OA, Kissoon N, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Lumba-Brown A, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. \u003cem\u003eNeurosurgery.\u003c/em\u003e 2020 Sep 1;87(3):427-434. doi: 10.1093/neuros/nyaa278. PMID: 32761068; PMCID: PMC7426189.\u003c/li\u003e\n\u003cli\u003eAlhashemi HH. Dysphagia in severe traumatic brain injury.\u003cem\u003e Neurosciences (Riyadh). \u003c/em\u003e2010 Oct;15(4):231-6. PMID: 20956918.\u003c/li\u003e\n\u003cli\u003ePamuk AE, Pamuk G, Bajin MD, Yildiz FG, Sennaroğlu L. Traumatic Facial and Vestibulocochlear Nerve Injury in The Internal Acoustic Canal in The Absence of A Temporal Bone Fracture.\u003cem\u003e J Int Adv Otol. \u003c/em\u003e2018 Aug;14(2):330-333. doi: 10.5152/iao.2018.4782. PMID: 30256206; PMCID: PMC6354463.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Brainstem auditory evoked potential(BAEP), Craniocerebral injury, Dysphagia","lastPublishedDoi":"10.21203/rs.3.rs-8225684/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8225684/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study was to explore the value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe role of BAEP in the diagnosis of dysphagia was studied by retrospectively analyzing the results of BAEP examination and the gold standard diagnosis of dysphagia in 106 patients with head injury.Inclusion criteria: ①Age 18\u0026thinsp;~\u0026thinsp;70 years old; ② Diagnosed by Chinese Expert Consensus on Evaluation and Treatment of Dysphagia. Exclusion criteria: ① Patients with a Glasgow coma scale score\u0026thinsp;\u0026le;\u0026thinsp;8 and patients who cannot be managed with intervention; ② Previous comorbidities that may affect swallowing function.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 65 males and 41 females patients were enrolled. The positive rate of BAEP in moderate to severe dysphagia was 86.96%, which was significantly higher than that in the mild dysphagia group (45.95%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). 60 patients were BAEP-positive and moderate-to-severe dysphagia patients, and considered neurogenic dysphagia, 46 patients were BAEP-negative, and considered non-neurophagia. The AUC of BAEP diagnosis of moderate to severe dysphagia was 0.705.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBAEP can be used as an accurate diagnostic method for nerve injury, it is helpful to identify whether it is a neurological dysphagia.\u003c/p\u003e","manuscriptTitle":"The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 10:56:26","doi":"10.21203/rs.3.rs-8225684/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-26T13:28:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31503296029570942479048257915039062509","date":"2026-04-16T12:46:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T03:07:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-02T15:16:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-29T05:31:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-29T05:31:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-28T01:50:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31f13ed1-4d31-4f5b-9b2b-63b9a27adf82","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66451017,"name":"Health sciences/Diseases"},{"id":66451018,"name":"Health sciences/Medical research"},{"id":66451019,"name":"Health sciences/Neurology"},{"id":66451020,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-04-20T10:56:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 10:56:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8225684","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8225684","identity":"rs-8225684","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}