Grebe Laura S, Wolf G, Schick B
Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
HNO. 2019 Jan;67(1):45-50. doi: 10.1007/s00106-018-0574-6.
Dysphagia is a common symptom reported by patients in various medical fields, raising the question of diagnosis. In addition to otorhinolaryngologic examination with a mirror, the current gold standards videofluoroscopy and fiber optic endoscopic evaluation of swallowing (FEES) are available. Ultrasound is frequently used in everyday clinical practice, although its application for swallowing diagnostics needs addressing.
Between April 2012 and February 2014, 81 subjects (age 19-66 years) with no indication of a swallowing disorder were sonographically examined. The anatomic representation of swallowing structures was evaluated and videos of the cervical part of the esophagus during swallowing of different consistencies (saliva, water, jelly) were recorded and analyzed. In a pilot study, the examination was tested on 3 dysphagia patients.
The base of the tongue, the intralaryngeal structures, the cervical spine, and the thyroid glands were well visualized. Sonographic representation of the cervical esophagus section was particularly successful. Its length could be detected at 5.78 ± 1.66 cm, the diameter measured at 0.88 ± 0.10 cm. Sonographic inspection of the sinus piriformis was most difficult; it could not be seen in 39.5% of cases. Visualization of the sinus piriformis was better in cases of normal weight and age <25 years (odds ratios 5.6 and 11.3, respectively). In the examination of patients with a swallowing disorder, three different pathologies (Forestier's disease, esophageal stenosis, and motor neuron disease) were identified as the cause of complaints.
Sonography enables very good visualization of swallowing and evaluation of the cervical esophagus. Where available, the otorhinolaryngologist should consider ultrasound as a diagnostic option, as it enables repeated evaluation of swallowing and can complement previously available diagnostic tools.
吞咽困难是各个医学领域患者报告的常见症状，这引发了诊断问题。除了使用镜子进行耳鼻喉科检查外，目前还有吞咽造影录像和纤维光学内镜吞咽功能评估（FEES）等金标准检查方法。超声在日常临床实践中经常使用，但其在吞咽诊断中的应用仍需探讨。
2012年4月至2014年2月期间，对81名无吞咽障碍迹象的受试者（年龄19 - 66岁）进行了超声检查。评估了吞咽结构的解剖表现，并记录和分析了吞咽不同质地食物（唾液、水、果冻）时食管颈部的视频。在一项试点研究中，对3名吞咽困难患者进行了该检查。
舌根部、喉内结构、颈椎和甲状腺均能清晰显示。食管颈部段的超声显示尤为成功。其长度可检测为5.78 ± 1.66厘米，直径测量为0.88 ± 0.10厘米。梨状窦的超声检查最为困难，39.5%的病例中无法看到。体重正常且年龄<25岁的患者梨状窦显示较好（优势比分别为5.6和11.3）。在对吞咽障碍患者的检查中，确定了三种不同的病理情况（Forestier病、食管狭窄和运动神经元病）为症状的病因。
超声能够很好地显示吞咽情况并评估食管颈部。在可行的情况下，耳鼻喉科医生应考虑将超声作为一种诊断选择，因为它能够对吞咽进行重复评估，并可补充现有的诊断工具。
