Department of Communicative Sciences and Disorders, NYU Steinhardt, New York.
Mount Sinai Beth Israel, New York, NY.
J Speech Lang Hear Res. 2018 Jul 13;61(7):1603-1612. doi: 10.1044/2018_JSLHR-S-17-0471.
It has been widely reported that a proportion of healthy, community-dwelling seniors will develop dysphagia in the absence of a known neurological, neuromuscular, or structural cause. Our objective was to test whether various feasible, noninvasive measures of swallowing could differentiate safe versus unsafe and efficient versus inefficient swallowing on videofluoroscopy (VF) in a sample of healthy seniors.
VFs from 44 (21 male, 23 female) healthy community-dwelling seniors (> 65 years old) were compared with a series of feasible, noninvasive swallowing metrics: maximal tongue strength (anterior and posterior), hand grip strength, pharyngeal volume, age, body mass index, 3-oz water swallow challenge, the 10-item Eating Assessment Tool questionnaire, and the Frailty Index. The VF protocol included 9 liquid barium boluses (3 × 5 ml thin, 3 × 20 ml thin, and 3 × 5 ml nectar). Each swallow was rated (randomized and blind) for safety using the Penetration-Aspiration Scale score and for efficiency using the Normalized Residue Ratio Scale (NRRS). Participants were deemed "unsafe" if they had any single Penetration-Aspiration Scale scores ≥ 3 and "inefficient" if they had any NRRS valleculae score > 0.082 or NRRS pyriform sinus score > 0.067. Univariate analyses of variance were run for each continuous swallowing measure by swallowing safety and swallowing efficiency status. Pearson's chi-square analyses were used to compare binary outcomes by swallow safety and efficiency status. Bonferroni corrections were applied to control for multiple comparisons.
None of the swallowing measures significantly differentiated safe from unsafe swallows. Although several variables trended to distinguishing efficient from inefficient swallows (age, 10-item Eating Assessment Tool, 3-oz water swallow challenge), only one variable, pharyngeal volume, was significantly different between efficient and inefficient swallows (p = .002).
Our findings support the notion that larger pharyngeal volumes (measured using acoustic pharyngometry) are associated with worse swallowing efficiency, a finding we attribute to atrophy of the pharyngeal musculature in healthy aging.
据广泛报道，在没有已知的神经、神经肌肉或结构原因的情况下，一部分健康的社区居住老年人会出现吞咽困难。我们的目的是测试在健康老年人的样本中，各种可行的、非侵入性的吞咽测量方法是否可以在视频透视（VF）上区分安全与不安全、有效与无效的吞咽。
比较了 44 名（21 名男性，23 名女性）健康社区居住老年人（>65 岁）的 VF 与一系列可行的、非侵入性的吞咽测量方法：最大舌力（前后）、手握力、咽部容量、年龄、体重指数、3 盎司水吞咽挑战、10 项饮食评估工具问卷和衰弱指数。VF 方案包括 9 个液体钡剂球（3×5ml 稀薄、3×20ml 稀薄和 3×5ml 花蜜）。每个吞咽均根据渗透-吸入量表评分进行安全性评定，并根据标准化残留比评分（NRRS）进行效率评定（随机和盲法）。如果任何单一的渗透-吸入量表评分≥3，则认为参与者为“不安全”；如果任何 NRRS 会厌谷评分>0.082 或 NRRS 梨状隐窝评分>0.067，则认为参与者为“无效”。对每个连续吞咽测量值进行吞咽安全性和吞咽效率状态的单变量方差分析。使用 Pearson 卡方分析比较吞咽安全性和效率状态的二分结果。应用 Bonferroni 校正控制多重比较。
没有任何吞咽测量方法能显著区分安全与不安全的吞咽。尽管几个变量趋向于区分有效与无效的吞咽（年龄、10 项饮食评估工具、3 盎司水吞咽挑战），但只有一个变量，即咽部容量，在有效与无效的吞咽之间存在显著差异（p=0.002）。
我们的研究结果支持这样一种观点，即较大的咽部容量（使用声学咽腔测量法测量）与较差的吞咽效率相关，我们将这一发现归因于健康衰老中咽肌萎缩。
