Tabaee Abtin, Johnson Paul E, Gartner Carolyn J, Kalwerisky Kevin, Desloge Rosemary B, Stewart Michael G
Department of Otolaryngology-Head and Neck Surgery, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA.
Laryngoscope. 2006 May;116(5):821-5. doi: 10.1097/01.mlg.0000214670.40604.45.
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.
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.
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.
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.
本研究的目的是比较吞咽困难测试中视频荧光吞咽造影检查（VFS）与带感觉测试的吞咽功能纤维内镜评估（FEESST）的结果。
作者对一家三级医疗中心在4年期间收集的数据进行了回顾性分析。对在2周内接受这两项检查的患者的FEESST和VFS结果进行吞咽功能方面的比较。比较分为完全一致、不会导致饮食建议有显著差异的轻微不一致以及会导致饮食建议有显著差异的重大不一致。计算二次加权kappa值以评估测试间的一致性。
54名患者符合纳入标准并接受了评估。41%的患者在进行FEESST时无法经口进食，两次检查的平均间隔时间为5天。喉镜检查显示93%的患者存在水肿/红斑，66%的患者咽缩功能受损，82%的患者喉咽感觉减退，30%的患者喉内收肌反射消失。所有黏稠度的FEESST检查显示89%的患者有食物潴留，83%的患者有食物穿透，65%的患者有误吸。VFS检查显示65%的患者有食物潴留，67%的患者有食物穿透，54%的患者有误吸。FEESST和VFS的比较显示，52%的患者结果完全一致，13%的患者结果轻微不一致，35%的患者结果重大不一致。加权kappa值为0.324，表明这两项测试之间仅有“中等”一致性。
FEESST和VFS可能并非可比的吞咽困难测试方法。需要进一步对吞咽功能测试进行比较研究，以确定吞咽困难测试的理想方法。
