Pflug C, Flügel T, Nienstedt J C
Klinik und Poliklinik für Hör‑, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
HNO. 2018 Jul;66(7):506-514. doi: 10.1007/s00106-017-0433-x.
Demographic developments and medical progress will cause the already high prevalence of swallowing disorders to increase further in the future. With the same number of specialists and economic resources, it is necessary to improve the efficiency of dysphagia diagnostics and continue to offer patients a treatment concept tailored to their needs. Manifold and often co-existing causes of dysphagia require interdisciplinary cooperation in this area. Endoscopic swallowing diagnostics play a prominent role in dysphagia diagnostics and should always contain thorough endoscopy of the upper aerodigestive tract-the domain of the ENT specialist and phoniatrician. The concept of a dysphagia day clinic under phoniatric leadership presented here allows for complete and efficient evaluation of swallowing disorders, and offers the patient a comprehensive treatment concept. Technical innovations such as the use of narrow band imaging (NBI) to significantly enhance visualization of the bolus in an endoscopic swallowing examination, as well as special methods like the "dipping maneuver" to allow a close-up examination of the subglottis and trachea were able to improve endoscopic dysphagia diagnosis even further. The examination procedure and the selection of test consistencies and placebo tablets should be tailored individually to the patient, and not follow strict procedures. The task of the ENT specialist or phoniatrician should be to assess and advise each patient individually, depending on underlying illnesses, prognosis, living conditions, and their own wishes. An interdisciplinary team of physicians and therapists permits individual counseling and therapy planning.
人口结构的变化和医学的进步将导致吞咽障碍的高患病率在未来进一步上升。在专家数量和经济资源不变的情况下,有必要提高吞咽困难诊断的效率,并继续为患者提供符合其需求的治疗方案。吞咽困难的病因多种多样且常常并存,这就需要该领域的跨学科合作。内镜吞咽诊断在吞咽困难诊断中发挥着重要作用,并且应始终包括对上呼吸道消化道进行全面的内镜检查,这是耳鼻喉科专家和嗓音治疗师的领域。本文介绍的在嗓音治疗师主导下的吞咽困难日间门诊概念,能够对吞咽障碍进行全面且高效的评估,并为患者提供全面的治疗方案。诸如使用窄带成像(NBI)以显著增强内镜吞咽检查中食团的可视化效果等技术创新,以及像“蘸取动作”这样的特殊方法以对声门下和气管进行近距离检查,能够进一步改善内镜吞咽困难诊断。检查程序以及测试一致性和安慰剂片剂的选择应根据患者个体情况进行调整,而不是遵循严格的程序。耳鼻喉科专家或嗓音治疗师的任务应该是根据患者的潜在疾病、预后、生活条件以及他们自己的意愿,对每位患者进行单独评估并提供建议。医生和治疗师组成的跨学科团队能够进行个性化咨询和治疗规划。