Kamarunas Erin E, McCullough Gary H, Guidry Tiffany J, Mennemeier Mark, Schluterman Keith
Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 826, Little Rock, AR, 72205, USA,
Dysphagia. 2014 Feb;29(1):33-43. doi: 10.1007/s00455-013-9473-x. Epub 2013 Jul 5.
Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. The purpose of this double-blind, randomized, controlled, crossover clinical trial was to determine how gel TNA during flexible endoscopic evaluation of swallowing with sensory testing affects sensation, swallowing, and comfort rating scores in healthy non-dysphagic participants. Laryngopharyngeal sensory thresholds and swallowing durations were compared between two conditions: TNA and sham. Transition duration decreased statistically significantly during the TNA condition compared to the sham for 10 ml only (p < 0.05). All other swallowing measures did not change between the conditions. Laryngopharyngeal sensory thresholds and perceptions did not change between conditions. No change was observed for subject comfort scores, ease of exam, or quality of view. Future studies should evaluate TNA administration variables, including concentration, dosage amount, and method of application, to determine the optimal strategy for providing comfort while avoiding altered swallowing.
在纤维内镜吞咽功能评估（FEES）并进行感觉测试（FEESST）时，有人对使用局部鼻腔麻醉（TNA）提出了反对意见，主要是因为存在使咽和喉黏膜脱敏并影响吞咽的感觉和运动方面的可能性。此外，有人认为在FEES期间TNA并非必要，因为它并不能提高患者的舒适度，也不会使内镜检查者的操作更轻松。这项双盲、随机、对照、交叉临床试验的目的是确定在进行吞咽功能的柔性内镜评估并进行感觉测试时使用凝胶TNA如何影响健康的非吞咽困难参与者的感觉、吞咽和舒适度评分。比较了两种情况（TNA和假处理）下的喉咽感觉阈值和吞咽持续时间。仅在10毫升的TNA情况下，与假处理相比，过渡持续时间有统计学意义的显著降低（p < 0.05）。其他所有吞咽指标在两种情况下均未改变。喉咽感觉阈值和感觉在两种情况下也没有变化。受试者的舒适度评分、检查的难易程度或视野质量均未观察到变化。未来的研究应评估TNA的给药变量，包括浓度、剂量和应用方法，以确定在避免吞咽改变的同时提供舒适度的最佳策略。
