In fact, you are right in several of the comments you extracted from the article published by Belafsky in 2008. However, we believe, as explained in our article, that the experience and results with EAT-10 provided by many clinical research teams from all around the world during the last 15 years, and summarized in our article, fully supports its use as a screening tool for oropharyngeal dysphagia (OD).

As defined by Belafsky in its original study, “the EAT-10 is a self-administered survey instrument for the subjective assessment of dysphagia”. You are right in that Belafsky et al. studied the validity and reliability of the use of the EAT-10 tool not only in patients with oropharyngeal dysphagia, but also in patients with esophageal dysphagia, head and neck cancer and gastroesophageal reflux disease. As proposed by Belafsky, the EAT-10 tool was developed to «document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders (1). This objective aligns with our paper’s scope, as we sought to explore the specific application of this screening tool in patients with OD and to achieve this goal, we analyzed up to 47 studies described in table 1 of our manuscript.

We want to clarify that we do not propose the EAT-10 tool as a diagnostic substitute or a replacement for the current gold standard of dysphagia diagnosis. As stated in our paper, we emphasize that «The use of this standardized screening tool could serve as a primary screening instrument for OD in routine clinical practice across a wide range of diseases and settings, thereby enhancing the likelihood of early diagnosis and management” (2). As clearly explained in our manuscript, the diagnostic algorithm of OD (Figure 2) requires a three-step approach consisting of clinical screening and clinical and instrumental assessments. Patients who have ‘failed’ the screening test are at risk of OD and require further clinical and/or instrumental assessment(s). The screening phase aims to identify patients at risk for OD, the clinical assessment aims to identify clinical signs and symptoms for OD, and the instrumental assessment aims to identify the mechanisms and pathophysiology of impaired safety and/or efficacy of swallowing and to select the optimal treatment. You are right in that the optimal sentence for our paper should be “…EAT-10 could provide a standardized way of reporting and identifying the prevalence of patients at risk for OD”.

It is interesting that even after nearly two decades after its introduction, ongoing research on the EAT-10 tool continues (3). In fact, the “European Laryngological Society” and the «Union of the European Phoniatricians” consider using the EAT-10 as an assessment tool for dysphagia (Grade of Recommendation B) in their recent “European Guidelines for the Assessment of Voice Quality in Clinical Practice” (4).

We recognize that the tool should not remain stagnant in its initial design and purpose. There is ample room for improvement and further research, as all phenotypes of patients at risk have the right to be screened for OD. New screening tools based on Artificial Intelligence and data science are emerging to pave the way for universal, accurate, and ultrafast screening of all phenotypes of patients at risk for OD (5).