Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520-8041, USA.
Dysphagia. 2012 Jun;27(2):265-70. doi: 10.1007/s00455-011-9362-0. Epub 2011 Aug 21.
The purpose of this direct replication study was to confirm the incidence of vocal fold immobility (VFI) and its relationship to pharyngeal dysphagia and aspiration. Using a single-group consecutively referred case series, a total of 2,650 participants underwent fiberoptic endoscopic evaluation of swallowing between August 2003 and December 2007. Main outcome measures included overall incidence of VFI and aspiration status, with specific emphasis on age, gender, etiology and pharyngeal phase bolus flow characteristics, and side of VFI (right, left, or bilateral). These data were compared to and then combined with the original study (n = 1,452) for a total of 4,102 participants. Results indicated that the incidence of VFI was 4.3% (112/2,650), i.e., 27% (31/112) unilateral right, 58% (65/112) unilateral left, and 14% (16/112) bilateral. Incidence of aspiration was 22% (580/2,650). Of those with VFI, 40% (45/112) aspirated, i.e., 42% (13/31) unilateral right, 37% (24/65) unilateral left, and 50% (8/16) bilateral. An individual with VFI had 2.50 times the odds of aspirating as someone without VFI (95% CI = 1.86-3.37). For liquid aspiration, the odds ratio (OR) = 2.41 (95% CI = 1.77-3.28), and for puree aspiration, OR = 2.08 (95% CI = 1.47-2.93). Left VFI occurred most frequently due to surgical trauma. Liquid was aspirated more often than a puree. Males exhibited VFI more often than females. Side of VFI and age were not factors that increased the incidence of aspiration significantly. It was confirmed that VFI is not an uncommon finding during dysphagia testing and, when present, increased the odds of aspiration compared to a population already being evaluated for dysphagia.
本直接复制研究的目的是确认声带固定（VFI）的发生率及其与咽吞咽困难和吸入的关系。采用单组连续转诊病例系列，共有 2650 名参与者在 2003 年 8 月至 2007 年 12 月期间接受了纤维内镜吞咽评估。主要观察指标包括 VFI 的总体发生率和吸入状态，重点关注年龄、性别、病因和咽期食团流动特征，以及 VFI 的侧别（右侧、左侧或双侧）。这些数据与原始研究（n=1452）进行了比较，共有 4102 名参与者。结果表明，VFI 的发生率为 4.3%（112/2650），即 27%（31/112）为单侧右侧，58%（65/112）为单侧左侧，14%（16/112）为双侧。吸入的发生率为 22%（580/2650）。在 VFI 患者中，40%（45/112）有吸入，即 42%（13/31）为单侧右侧，37%（24/65）为单侧左侧，50%（8/16）为双侧。VFI 患者发生吸入的可能性是无 VFI 患者的 2.50 倍（95%CI=1.86-3.37）。对于液体吸入，比值比（OR）=2.41（95%CI=1.77-3.28），对于泥状食物吸入，OR=2.08（95%CI=1.47-2.93）。左侧 VFI 最常因手术创伤引起。液体比泥状食物更容易被吸入。男性比女性更常出现 VFI。VFI 的侧别和年龄并不是显著增加吸入发生率的因素。证实 VFI 在吞咽困难测试中并不罕见，并且当存在时，与已经接受吞咽困难评估的人群相比，发生吸入的可能性增加。
