纤维内镜吞咽功能检查在鼻咽癌放化疗后吞咽障碍评估中的应用

目的 探讨纤维内镜吞咽功能检查(FEES)在鼻咽癌放/化疗后吞咽障碍评估中的应用价值。方法 对37例经放/化疗后的鼻咽癌患者进行安德森吞咽障碍量表检查(MDADI)、FEES、吞咽X线荧光透视检查,对检查结果进行分析。结果 FEES吞咽障碍的阳性检测率为70.27%,高于吞咽X线荧光透视检查的吞咽障碍阳性检测率48.65%(P＜0.05),差异具有统计学意义。FEES与吞咽X线荧光透视检查的一致性较强(Kappa值为0.358)。FEES与量表评估检查一致性(Kappa值为0.340)优于吞咽X线荧光透视检查与量表评估检的一致性(Kappa值为0.194)。结论 FEES可应用于鼻咽癌放/化疗后吞咽障碍的评估,值得临床推广。     

吞咽障碍的临床评估

目的 探讨吞咽障碍的评估方法.方法 回顾性分析2010年6月至2012年7月间诊治的37例吞咽障碍患者的临床资料.神经系统疾病12例,咽食管入口部因素14例,头颈部恶性肿瘤及咽部反复溃疡放疗后远期吞咽障碍6例,无明显原因5例.评估方法包括:洼田饮水试验、藤岛吞咽障碍评价标准评估、吞咽造影检查(videofluoroscopic swallowing study,VFSS)和内镜吞咽检查(fibroptic endoscopic evaluation of swallowing,FEES).结果 洼田饮水试验有14例(14/37)表现为异常;吞咽障碍评价标准异常为29例(29/37);VFSS误吸评分异常为27例(27/37),VFSS吞咽困难评分异常为33例(33/37),FEES评估异常为19例(19/21).洼田饮水试验、吞咽障碍评价标准与VFSS 之间一致性分析的Kappa值分别为0.137和0.416.以VFSS为评价“金标准”,FEES评价喉渗漏或误吸的敏感度、特异度、阳性预测值和阴性预测值分别为88.9％,66.7％,94.1％和50.0％.结论 洼田饮水试验和吞咽障碍评价标准可用于临床筛查和效果初评,使用方便;VFSS和FEES能精确评估吞咽障碍性质、部位及程度.多种评估方法的联合运用是吞咽障碍的诊治的最重要依据.     

吞咽生命质量量表联合纤维内镜下吞咽功能检查技术在鼻咽癌放化疗后吞咽障碍患者中的应用

目的 吞咽生命质量量表(SWAL-QOL)联合纤维内镜下吞咽功能检查技术(FEES)对鼻咽癌放化疗后吞咽障碍患者的吞咽功能进行评估,以了解经放化疗后的鼻咽癌患者的吞咽相关生活质量情况,并拓展二者在临床中的应用。 方法 纳入2019年9月至2020年3月在四川大学华西医院随访的经放化疗治疗的、且存在吞咽障碍的162例鼻咽癌患者为病例组,纳入健康人144例为对照组,两组均填写SWAL-QOL。并对病例组96例患者进行FEES检查,再根据渗漏/误吸量表(PAS)对其吞咽障碍严重程度进行分级。 结果 病例组SWAL-QOL中生活质量量表的总分(124.69±25.57)及吞咽症状维度得分(58.56±9.46)均明显低于对照组,且组间差异有统计学意义(P<0.05);生活质量量表中,除“疲劳”“睡眠”维度外,其余8个维度差异均具有统计学意义(P<0.05)。根据PAS评分显示,无渗漏组22例(22.92%),喉渗漏组60例(62.50%),隐性误吸组14例(14.58%),分组比较:3组病例对比发现,SWAL-QOL总分及“言语交流”“进食恐惧”“疲劳”“睡眠”各维度差异具有统计学意义(P<0.05)。对比无渗漏组与喉渗漏组SWAL-QOL总分、吞咽症状维度评分及生活质量量表各维度的差异均无统计学意义(P>0.05)。对比无渗漏组和隐性误吸组,SWAL-QOL总分、进食时间、言语交流、睡眠各维度的差异有统计学意义(P<0.05),但吞咽症状及其他维度差异无统计学意义(P>0.05)。对比喉渗漏组和隐性误吸组,SWAL-QOL总分,“言语交流”“睡眠”各维度差异有统计学意义(P<0.05),吞咽症状及其他维度差异无统计学意义(P>0.05)。 结论 吞咽障碍对鼻咽癌放化疗后患者生活质量影响是多方面的;SWAL-QOL可联合FEES技术,并结合PAS评分对经放化疗后的鼻咽癌患者的吞咽功能进行评估及吞咽障碍严重程度分级,且PAS分级越高,其SWAL-QOL的评分越低。     

鼻咽癌放疗后远期吞咽功能的纤维喉镜评估

目的 探讨纤维喉镜吞咽检查在鼻咽癌放疗后长期存活患者吞咽功能评估的应用价值。 方法 通过对107例鼻咽癌放疗后长期存活的患者进行纤维喉镜检查,应用咽期残留量表及食物渗透及误吸量表评估咽期残留、渗透及误吸情况。 结果 107例患者均完成纤维喉镜吞咽评估,鼻咽癌放疗后随诊时间为5~14年,平均(8.78±2.91)年,声门内收反射减弱或消失22例(20.56%),鼻咽反流及关闭不全23例(21.49%),声带活动减弱或声带麻痹50例(46.72%)。53.06%患者存在对于粥样食物严重梨状窝残留,而45.79%患者对水以及29.90%患者对粥样食物存在误吸。 结论 通过对鼻咽癌放疗后长期存活患者进行纤维喉镜吞咽评估,较多患者存在严重吞咽障碍,其中粥样食物残留及水样食物误吸较常见。     

健康成年人咽部吞咽功能客观参数的测量

目的 通过吞咽动力学研究了解并初步建立成年国人咽部吞咽功能相关参数的客观数值.方法 对年龄20～60岁的男女各40例健康成人志愿者进行X线动态吞咽造影检查并录像,然后通过图像分析测量软件Avidemux 2.5及Image J计算测量在吞咽过程中与咽部吞咽功能密切相关的客观参数,如舌骨的最大移动距离、钡剂通过咽腔的时间、咽腔的收缩率及食管入口的最大开放程度.结果 在80例志愿者中,舌骨的最大移动平均距离(x±s,下同)为(1.91 ±0.48) cm,钡剂通过咽腔的时间为(0.82±0.15)s,咽腔的缩窄率为94.9％±3.41％,食管入口的最大开放程度为(0.91 ±0.05)cm.进一步分组分析发现,男性舌骨的最大移动距离(2.04±0.46)cm,明显大于女性(1.78 ±0.47)cm,差异具有统计学意义(t=2.44,P=0.017),但男女之间及男女不同年龄组之间钡剂通过咽腔的时间、咽腔收缩率及食管入口的最大开放程度差异均无统计学意义(P值均＞0.05).结论 本研究初步建立了成年国人咽部吞咽功能相关参数的客观数值,为更进一步地客观评估咽部吞咽障碍提供了研究基础.     

喉癌喉部分切除术后喉狭窄Ⅱ期喉重建术临床评价

目的使喉部分切除和扩大喉部分切除术后长期带管者去除气管套管,恢复喉的发音、呼吸、吞咽防护功能和正常颈部外观.方法对19例喉癌喉部分切除术后喉狭窄患者,应用颈前双蒂转门肌皮瓣等方法进行Ⅱ期喉重建术,其中包括垂直喉切除Ⅱ期喉重建术6例(6/19),扩大垂直喉切除术11例(11/19),额侧喉切除术2例(2/19).应用颈前双蒂转门肌皮瓣修复17例,胸骨舌骨肌瓣修复1例,胸锁乳突肌和筋膜修复1例.结果 3、5年生存率分别为91.7%(11/12)和3/5.19例中去除气管套管16例(其中包括2例行2次Ⅱ期喉重建术).总的气管套管拔出率为84.2%(16/19),应用转门肌皮瓣修复组拔管率为94.1%(16/17),胸骨舌骨肌瓣和胸锁乳突肌瓣修复组均未能拔管(0/2),拔管困难3例.术后全部患者能够发音,语言交流无困难.其中语音响亮清晰者为94.7%(18/19),重度声音嘶哑者为5.3%(1/19).全部患者恢复正常进食,绝大多数患者进食无误咽,2例初期进流食出现轻度误咽,1～2周误咽克服,恢复正常经口进食.结论中、晚期喉癌选择性地施行功能保全性喉手术是可行的;应用转门肌皮瓣进行Ⅱ期喉重建术,可使喉部分切除术后长期带管者去除气管套管,重新获得经口鼻呼吸和满意的发音、吞咽防护功能效果.     

环咽肌切开术治疗颈性吞咽困难

作者们报告33例环咽肌切开术,按病变分为三组:头颈部手术、神经外科手术和原发性神经原性病变。手术疗效分为:(1)优秀(进食良好无误吸),(2)良好(有轻微吞咽困难),(3)无效(仍有误吸)。部分患者术前接受咽食管动力学检查或胃肠X线造影检查。手术在全麻下进行,将40～44号Maloney探条插入食管。于环状软骨平面作横切口或在胸锁乳突肌前缘作斜切口。除非右侧声带麻痹或其他技术上的考     

声门型喉癌SCPL-CHEP术喉功能重建结果的评估

目的观察声门型喉癌SCPL-CHEP术后喉功能重建的结果,评价该术式对保留喉功能的价值.方法回顾分析37例声门型喉癌行SCPL-CHEP术后吞咽功能、呼吸功能、语言功能的恢复情况.其中T1b4例,T221例,T312例.结果随访2～5年,多数患者有不同程度的误吸,除1例外余者经训练均能克服吞咽障碍,3例拔管困难,拔管率为89.2%.33例(89.2%)术后主观语言功能评估指标达到日常要求,但有不同程度的声嘶.结论严格掌握手术适应证,提高手术技巧,科学的术后护理和指导,能改善SCPL-CHEP术后吞咽障碍,提高拔管率.SCPL-CHEP术或是声门型喉癌保留喉功能的有效术式.     

鼻咽癌放/化疗后吞咽障碍的临床评估

目的 遴选出安全、有效、便捷的鼻咽癌放/化疗后吞咽障碍的评估方法。方法 选取在邵阳市中心医院就诊的鼻咽癌患者37例,应用吞咽X线荧光透视检查（VFSS）、进食评估问卷调查量表（EAT-10）、安德森吞咽障碍量表（MDADI）、反复唾液吞咽试验（RSST）和洼田饮水试验（WST）对入组患者进行吞咽功能的评估,筛选适合鼻咽癌放/化疗后吞咽障碍评估的方法。结果 以VFSS为金标准,进食评估EAT-10的灵敏度为83.33%,MDADI灵敏度为72.22%,RSST特异度为84.21%,但这些方法与金标准的Kappa值都小于0.2,其一致性较低。WST特异度为78.95%,Kappa值大于0.2,具有相对较好的一致性。结论 WST与VFSS的一致性相对较好,可以作为鼻咽癌放/化疗后吞咽障碍的筛查工具,其他方法也可辅助评估。     

喉咳饮治疗喉源性咳嗽68例

笔者自2000年以来,运用自拟的喉咳饮治疗喉源性咳嗽68例,疗效满意。现报道如下。1资料与方法1.1临床资料68例患者中,男20例,女48例;年龄12～75岁;所有病例均符合喉源性咳嗽的诊断标准:咽痒、干咳无痰或少痰,呈阵发性咳嗽,声音粗糙或嘶哑、咽部有堵塞感,难以吞咽,伴有大便秘结等症状。血化验、胸部X线、气管镜和胸部CT检查均为正常结果。咽喉部检查:黏膜呈慢性充血,黏膜干燥状,并有淋巴滤泡增生。X线检查排除肺癌、肺结核等病     

Endoscopic and videofluoroscopic evaluations of swallowing and aspiration

A new procedure for evaluating oropharyngeal dysphagia utilizing fiberoptic laryngoscopy was compared to the videofluoroscopy procedure. Twenty-one subjects were given both examinations within a 48-hour period. Results of the fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy examinations were compared for presence or absence of abnormal events. Good agreement was found, especially for the finding of aspiration (90% agreement). The FEES was then measured against the videofluoroscopy study for sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity was 0.88 or greater for three of the four parameters measured. Specificity was lower overall, but was still 0.92 for detection of aspiration. It was concluded that the FEES is a valid and valuable tool for evaluating oropharyngeal dysphagia. Some specific patients and conditions that lend themselves to this procedure are discussed.     

Fiberoptic endoscopic evaluation of swallowing in the pediatric population

OBJECTIVE: To investigate the diagnostic and rehabilitative usefulness of routine fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population. STUDY DESIGN: Prospective, consecutive, blinded. PATIENTS AND METHODS: Thirty pediatric inpatients from a large, urban, tertiary care teaching hospital participated. Their ages ranged from 11 days to 20 years (mean, 10 years and 4 months). In a random fashion, seven subjects were assessed with both videofluoroscopic evaluation of swallowing (VFES) and FEES and 23 subjects were assessed solely with FEES. Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration. Rehabilitative strategies, e.g., positioning and modification of bolus consistencies, were based on diagnostic findings. RESULTS: There was 100% agreement between the blinded diagnostic results and implementation of rehabilitative strategies for subjects randomly assigned to receive both VFES and FEES and for subjects who received solely FEES. Of the 23 subjects assessed solely with FEES, 13 of 23 (57%) exhibited normal swallowing and 10 of 23 (43%) exhibited dysphagia. The feeding recommendation for 4 of 10 subjects with dysphagia (40%) was for a non-oral diet because of aspiration. FEES allowed for specific feeding recommendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to reduce aspiration risk in 6 of 10 subjects with dysphagia (60%). CONCLUSION: FEES can be used routinely to diagnose and treat pediatric dysphagia in the acute care setting.     

Assessing Penetration and Aspiration: How Do Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing Compare?

OBJECTIVES/HYPOTHESIS: We aimed to investigate whether the type of dysphagia examination (fiberoptic endoscopic evaluation of swallowing [FEES] or videofluoroscopy) influences the scoring of penetration and aspiration. STUDY DESIGN: Prospective, single-blind study. METHODS: Fifteen dysphagic participants were recruited and underwent one FEES and one videofluoroscopy examination, performed and recorded simultaneously. Fifteen independent raters from 12 centers scored penetration and aspiration from recordings using the Penetration Aspiration Scale. Raters were blind to participant details, the pairing of the FEES and videofluoroscopy recordings, and the other raters' scores. Interrater and intrarater reliability were analyzed using weighted kappa. RESULTS: The Penetration Aspiration Scale scores were significantly higher for the FEES recordings than for the videofluoroscopy recordings (ANOVA P < .001). The mean difference between the FEES and videofluoroscopy penetration aspiration scores for the same swallows was 1.15 points. Interrater and intrarater reliability ranged from 0.64 to 0.79 (weighted kappa). CONCLUSIONS: Penetration aspiration is perceived to be greater (more severe) from FEES than videofluoroscopy images. The clinical implications are discussed.     

Fiberoptic Endoscopic Evaluation of Swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings

Objective

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used as an adjunct to assess swallowing function in children with complex feeding disorders. We report the feeding outcomes of patients who underwent FEES to determine whether associations exist between clinical diagnoses or FEES findings and feeding outcomes.

Methods

Retrospective review of children who underwent FEES for dysphagia or aspiration from 2003 to 2009. The clinical diagnoses and initial FEES findings were compared to follow up feeding status for associations.

Results

79 patients were included (44 males and 35 females). The change from initial to final status: total oral feeding (42-67%), NPO ± minimal tastes (39-21%) and oral feeding with tube feeding (19-12%). Of the clinical diagnoses, tonsillar hypertrophy was associated with ultimately obtaining total oral feeding status (p = 0.046) while the inability to obtain total oral feeding status was associated with neurologic (p < 0.001). The initial FEES findings showed no significant associations with long-term feeding status.

Conclusion

Many children overcome their dysphagia but those with neurologic disorders are less likely to achieve total oral feeding status. In children with dysphagia evaluated by FEES, the long-term feeding status is not significantly associated with the initial FEES findings.     

The accuracy of the modified Evans blue dye test in detecting aspiration in head and neck cancer patients

The purpose of this study was to determine sensitivity and specificity of the modified Evans blue dye test (MEBDT) in tracheostomised patients after treatment of head and neck squamous cell carcinoma (HNSCC). This was a prospective study with 30 consecutive patients. All individuals underwent a MEBDT and a subsequent fiberoptic endoscopic evaluation of swallowing (FEES) immediately after the MEBDT for reconsidering the validity of the MEBDT. Aspiration was present in 20 patients documented by MEBDT and FEES. One patient was judged to aspirate by FEES but not by MEBDT (1 false-negative result). Nine patients showed no aspiration either by MEBDT or by FEES. The sensitivity of the MEBDT protocol in predicting aspiration among individuals in our cohort was 95.24%, the specificity 100%, respectively. The results of the current investigation suggest that the MEBDT is much more sensitive in tracheostomised HNSCC patients than in tracheostomised neurological patients. The MEBDT for tracheostomised HNSCC patients offers a quick and reliable method to identify aspiration risk in cases of severe dysphagia.     

The utility of the fiberoptic endoscopic evaluation of swallowing (FEES) in diagnosing and treating children with Type I laryngeal clefts

This case series of three young children with type I laryngeal clefts is presented to demonstrate the utility of fiberoptic endoscopic evaluation of swallowing (FEES) in managing these patients. FEES revealed laryngeal penetration in a posterior to anterior direction in two patients and penetration from lateral to medial in the third patient. The type of laryngeal penetration helped in making the diagnosis of a type I cleft in two children and helped establish a safe feeding regiment in the third child. Patients with type I laryngeal clefts are often misdiagnosed, most likely resulting from the complex presentation of signs/symptoms and the difficulty of detecting small clefts with currently available tests. The pattern of laryngeal aspiration seen with FEES can help in diagnosis and management in this patient population.     

Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy

OBJECTIVE: The objective of this study was to compare the results of videofluoroscopy (VFS) with flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagia testing. METHODS: The authors conducted a retrospective review of data collected over a 4-year period at a tertiary care medical center. The FEESST and VFS results for patients receiving both examinations within a 2-week period were compared with respect to swallowing function. Comparisons were categorized as full agreement, minor disagreement that would not result in a significant difference in diet recommendations, and major disagreement that would result in a significant difference in diet recommendations. Kappa with quadratic weighting was calculated to evaluate the inter-test agreement. RESULTS: Fifty-four patients met inclusion criteria and were reviewed. Forty-one percent of patients were not eating by mouth at the time of FEESST and the mean interval between the two examinations was 5 days. Laryngeal examination revealed edema/erythema in 93%, impaired pharyngeal squeeze in 66%, decreased laryngopharyngeal sensation in 82%, and absent laryngeal adductor reflex in 30%. FEESST with all consistencies revealed pooling in 89%, penetration in 83%, and aspiration in 65% of patients. VFS revealed pooling in 65%, penetration in 67%, and aspiration in 54% of patients. Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients. A weighted kappa value of 0.324 signified only "fair" agreement between the two tests. CONCLUSIONS: FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.