Yin Tary, Jardine Marie, Miles Anna, Allen Jacqui
Department of Otolaryngology, North Shore Hospital, Auckland, New Zealand.
University of Auckland, Auckland, New Zealand.
Eur Arch Otorhinolaryngol. 2018 Sep;275(9):2317-2323. doi: 10.1007/s00405-018-5057-6. Epub 2018 Jul 12.
Structural and functional pharyngeal changes occur with age. How these affect swallowing in healthy older adults is not well defined. This study presents quantitative pharyngeal anatomic features in healthy adults using videofluoroscopic study of swallowing (VFSS). This will help our understanding of the normal changes in swallowing that occur with age and illustrate what may constitute normal variation compared with abnormal swallow function.
138 mixed gender adults with no history of dysphagia were recruited and underwent a standardized VFSS protocol. Parameters including age, BMI, and gender were correlated with the presence of a cricopharyngeal bar, spinal changes and pharyngeal wall thickness at rest.
46% of participants had notable spinal changes. 8% of participants demonstrated cricopharyngeal bars and 12% of subjects revealed osteophytes. Age positively correlated with the presence of a cricopharyngeal bar (r = 0.281, p < 0.001) and presence of osteophytes (r = 0.334, p < 0.001). The incidence of cricopharyngeal bars in adults over 70 years old was 16%.
A significant number of healthy adults with no swallowing complaints have variant pharyngeal anatomic findings such as cervical vertebral osteophytes and cricopharyngeal bars. This must be taken into account when assessing patients with dysphagia complaints to avoid misattribution of symptoms to these potentially asymptomatic variants. This ensures correct recommendations are made regarding management including diet modification, compensatory strategies, and surgical intervention.
咽部的结构和功能会随着年龄增长而发生变化。目前尚不清楚这些变化如何影响健康老年人的吞咽功能。本研究通过吞咽视频荧光造影检查（VFSS）呈现了健康成年人咽部的定量解剖特征。这将有助于我们理解随着年龄增长吞咽功能的正常变化，并阐明与异常吞咽功能相比，哪些可能构成正常变异。
招募了138名无吞咽困难病史的成年男女，他们接受了标准化的VFSS检查方案。将年龄、体重指数（BMI）和性别等参数与环咽肌条的存在、脊柱变化以及静息时的咽壁厚度进行关联分析。
46%的参与者有明显的脊柱变化。8%的参与者显示有环咽肌条，12%的受试者有骨赘。年龄与环咽肌条的存在（r = 0.281，p < 0.001）和骨赘的存在（r = 0.334，p < 0.001）呈正相关。70岁以上成年人中环咽肌条的发生率为16%。
大量无吞咽主诉的健康成年人存在咽部解剖结构变异，如颈椎骨赘和环咽肌条。在评估有吞咽困难主诉的患者时，必须考虑到这一点，以避免将症状错误归因于这些可能无症状的变异。这确保了在包括饮食调整、代偿策略和手术干预等管理方面能做出正确的建议。
