Kang Christina H, Hentz Joseph G, Lott David G
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
Department of Health Science Research, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Otolaryngol Head Neck Surg. 2016 Nov;155(5):837-842. doi: 10.1177/0194599816657013. Epub 2016 Jun 28.
To identify symptoms, common diagnostic findings, pattern of treatments and referrals offered, and their efficacy in a group of patients with idiopathic functional dysphagia in an otolaryngology setting with multiple providers.
Case series with chart review.
Tertiary academic center.
Following Mayo Clinic Institutional Review Board approval, a retrospective chart review was conducted of patients with dysphagia who had a videofluoroscopic swallow study between January 1, 2013, and April 30, 2015. Each patient's dysphagia symptomology, videofluoroscopic swallow study, flexible laryngoscopy, and medical chart were reviewed to identify the treatment paradigms that were utilized.
Sixty-seven adult patients met the inclusion criteria. Abnormal laryngeal muscle tension was present in 97% of patients. Eighty-two percent of patients also demonstrated signs of laryngeal hyperresponsiveness. Nonspecific laryngeal inflammation was evident in 52% of patients. Twenty-seven patients were referred to speech-language pathology for evaluation. Thirteen patients completed a course of voice therapy directed toward unloading muscle tension. All 13 patients self-reported resolution of dysphagia symptoms.
The study results suggest that laryngeal muscle tension may be a factor in the underlying etiology in patients with idiopathic functional dysphagia. We propose the diagnostic term muscle tension dysphagia to describe a subset of patients with functional dysphagia. Further prospective studies are needed to better evaluate potential gastroesophageal confounders in this group of patients and to identify an effective paradigm for treatment. In our limited series, speech-language pathology intervention directed toward unloading muscle tension appears effective.
在有多个医疗服务提供者的耳鼻喉科环境中，确定一组特发性功能性吞咽困难患者的症状、常见诊断结果、所提供的治疗模式和转诊情况及其疗效。
病历回顾的病例系列研究。
三级学术中心。
经梅奥诊所机构审查委员会批准，对2013年1月1日至2015年4月30日期间进行了视频荧光吞咽造影检查的吞咽困难患者进行回顾性病历审查。审查了每位患者的吞咽困难症状、视频荧光吞咽造影检查、纤维喉镜检查和病历，以确定所采用的治疗模式。
67名成年患者符合纳入标准。97%的患者存在喉肌紧张异常。82%的患者还表现出喉高反应性迹象。52%的患者有非特异性喉部炎症。27名患者被转诊至言语病理学进行评估。13名患者完成了旨在减轻肌肉紧张的嗓音治疗疗程。所有13名患者均自我报告吞咽困难症状得到缓解。
研究结果表明，喉肌紧张可能是特发性功能性吞咽困难患者潜在病因中的一个因素。我们建议使用诊断术语“肌肉紧张性吞咽困难”来描述功能性吞咽困难患者的一个亚组。需要进一步的前瞻性研究，以更好地评估该组患者潜在的胃食管混杂因素，并确定有效的治疗模式。在我们有限的系列研究中，针对减轻肌肉紧张的言语病理学干预似乎是有效的。
