Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan.
Department of Oral and Maxillofacial Surgery, Kuwana City Medical Center, Mie, Japan.
Odontology. 2020 Jan;108(1):117-123. doi: 10.1007/s10266-019-00431-9. Epub 2019 Apr 29.
Dysphagia prevalence has increased with increasing elderly population worldwide. Therefore, early detection of dysphagia has become increasingly important. Repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), and cervical auscultation, which are convenient for non-experts to assess eating and swallowing and have been frequently used in Japan since 20 years. Using aspiration and pharyngeal residues, the objective of this study was to elucidate the efficacy of the three screening tests performed by non-experts in patients who had swallowing disorders. In total, 102 patients with cerebrovascular diseases who were suspected of having dysphagia were assessed. A swallowing team assessed their swallowing capabilities; videofluoroscopy and screening tests were performed. RSST, MWST, and cervical auscultation were performed by junior dentists who were non-experts in dysphagia. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in each examination were evaluated using results of aspiration in videofluoroscopy and pharyngeal residues. For aspiration, the highest sensitivity with cervical auscultation (VES) was 93.7%. For pharyngeal residue, the highest sensitivity with cervical auscultation (VES) was 84.3%. For piriform sinus residue, the highest sensitivity with cervical auscultation (VES) was 86.4%. Despite being evaluated by a non-expert, the sensitivity of cervical auscultation (VES) and MWST was ≥ 80%, suggesting their effectiveness as prescreening tests, although the range of specificity was 25.5-68.4% in all examinations. These tests are easy to perform and useful to screen for aspiration or pharyngeal residues before precision tests.
全球老年人口增加，使吞咽困难的患病率也随之升高。因此，早期发现吞咽困难变得越来越重要。重复唾液吞咽测试（RSST）、改良饮水吞咽测试（MWST）和颈部听诊，这些测试方便非专业人员评估进食和吞咽能力，在日本已经使用了 20 多年。本研究使用吸入物和咽部残留物，旨在阐明非专业人员进行的三项筛查测试对吞咽障碍患者的效果。共评估了 102 名疑似吞咽困难的脑血管病患者。吞咽小组评估了他们的吞咽能力；进行了视频荧光透视检查和筛查测试。RSST、MWST 和颈部听诊由非吞咽障碍专业的初级牙医进行。使用视频荧光透视检查中的吸入物和咽部残留物评估每个检查的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比。对于吸入物，颈部听诊（VES）的敏感性最高为 93.7%。对于咽部残留物，颈部听诊（VES）的敏感性最高为 84.3%。对于梨状隐窝残留物，颈部听诊（VES）的敏感性最高为 86.4%。尽管由非专业人员进行评估，但颈部听诊（VES）和 MWST 的敏感性均≥80%，表明它们作为预筛查测试是有效的，尽管所有检查的特异性范围为 25.5-68.4%。这些测试易于进行，在进行精确测试之前，对吸入物或咽部残留物进行筛查很有用。
