Krasnodębska Paulina, Szkiełkowska Agata, Jarzyńska-Bućko Agnieszka, Włodarczyk Elżbieta, Miaśkiewicz Beata
Klinika Audiologii i Foniatrii, Instytut Fizjologii i Patologii Słuchu, Warszawa, Polska.
Klinika Audiologii i Foniatrii, Instytut Fizjologii i Patologii Słuchu, Warszawa, Katedra Audiologii i Foniatrii, Uniwersytet Muzyczny Fryderyka Chopina, Warszawa, Polska.
Otolaryngol Pol. 2019 Sep 2;74(2):17-22. doi: 10.5604/01.3001.0013.4123.
Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles.
The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder.
The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.
吞咽困难与嗓音障碍并存是文献中很少提及的话题。特别关注喉肌和咽肌功能障碍这一方面。
本研究的目的是分析嗓音障碍患者中吞咽障碍并存的情况。
研究材料包括2018年因嗓音障碍住院的515例患者。经访谈表明有吞咽困难的患者接受了吞咽障碍的额外诊断（纤维内镜吞咽功能检查、扩展言语治疗测试、表面肌电图）。
11.8% 需要治疗嗓音障碍的人报告并存吞咽困难。吞咽障碍的诊断率为9.3%。被诊断为吞咽障碍的受访者比例因基础疾病类型而异，在神经系统疾病组中最高。对吞咽障碍严重程度（根据评估等级、嗓音障碍指数、吞咽困难评估工具-10结果）与嗓音障碍指数严重程度之间的相关性分析显示，嗓音障碍指数与吞咽困难评估工具-10之间存在弱相关性（p = 0.1），在诊断为神经系统疾病的人群中，嗓音障碍指数值与反流症状指数之间存在统计学显著相关性（p < 0.05），在功能亢进性嗓音障碍患者中，嗓音障碍指数值与嗓音障碍指数之间存在相关性，在慢性喉炎患者中，嗓音障碍指数值与体重指数和吞咽困难评估工具-10之间存在相关性。此外，吞咽障碍严重程度与吞咽困难评估工具-10和嗓音障碍指数之间存在统计学显著相关性（p < 0.05）。言语治疗测试表明存在吞咽模式不规范的并存问题。肌电图研究显示，在记录咬肌的平均和最大振幅时，不对称性最大。
嗓音障碍患者的治疗需要多学科护理。这些患者的吞咽困难病史应补充嗓音障碍病史。吞咽障碍的特征因嗓音障碍的原因而异，它们的并存平均影响9.3% 的患者。肌肉紧张性吞咽困难与嗓音障碍并存需要单独的诊断方案。言语治疗程序应该是肌肉紧张性吞咽困难患者多学科护理的关键要素。
