Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, U.S.A.
Department of Otolaryngology Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.
Laryngoscope. 2021 Jun;131(6):1217-1222. doi: 10.1002/lary.28885. Epub 2020 Jul 20.
Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP.
Prospective Cohort Study.
Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP.
Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05).
Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP.
3 (Prospective Observational Study) Laryngoscope, 131:1217-1222, 2021.
进行性核上性麻痹（PSP）是一种神经退行性疾病，可导致咳嗽和吞咽功能障碍以及吸入性肺炎。在相关疾病中已经确定了声带萎缩、咳嗽和吞咽之间的关系，但在 PSP 中仍不清楚。本研究检查了：1）PSP 中声带弯曲的患病率，以及 2）声带弯曲对 PSP 中咳嗽和吞咽的影响。
前瞻性队列研究。
23 名 PSP 患者完成了咳嗽和吞咽的仪器评估。使用纤维喉镜评估声带弯曲（BI）和吞咽安全性（PAS）。使用肺活量计获得咳嗽效果的测量值。统计分析用于确定轻度至中度（BI>0）和重度（BI>12.2）弯曲的频率，并评估 BI 对 PSP 中 PAS 和咳嗽效果的影响。
52%（n=12）的参与者表现出严重弯曲，而 48%（n=11）表现出轻度至中度弯曲。与轻度至中度 BI 相比，严重 BI 参与者的自愿咳嗽呼气峰流速（P=0.01）以及反射（P=0.02）和自愿（P=0.005）咳嗽体积加速度均较低。然而，BI 并未影响 PAS（P>0.05）。
本研究的结果表明，声带弯曲在 PSP 中非常普遍，并且与反射和自愿咳嗽效果降低有关。这些发现为这一患者群体气道保护受损的病理生理学提供了深入了解。未来的研究应将声带萎缩作为 PSP 中行为和医学干预的治疗靶点进行研究。
3（前瞻性观察性研究）喉镜，131：1217-1222，2021。
