Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Laryngoscope. 2024 Aug;134(8):3519-3526. doi: 10.1002/lary.31358. Epub 2024 Feb 23.
In pharyngeal dysphagia, poor pharyngeal contraction and upper esophageal sphincter (UES) dysfunction result in post-swallow saliva residue (SR). This study aimed to clarify the relationship between swallowing pressure and SR in the valleculae and piriform sinuses on flexible endoscopic evaluation of swallowing (FEES).
Pharyngeal dysphagia patients with Wallenberg syndrome were included. Amounts of post-swallow SR in the valleculae and piriform sinuses were classified into four grades using SR scores based on FEES. The Hyodo score was also calculated to evaluate swallowing function. High-resolution manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro-hypopharyngeal, and UES zones on swallowing were obtained for comparison with SR and Hyodo scores.
Of the 31 recruited, data from 26 patients who successfully underwent FEES and manometry were analyzed. Vallecular SR scores were strongly negatively correlated with a maximum pressure of the oropharynx (r = -0.52, p = 0.006), distal contractile integrals (DCI) of the oropharynx (r = -0.52, p = 0.007), and DCI of the oro-hypopharynx (r = -0.55, p = 0.004). Hyodo scores for parameters 1 and 4 (corresponding to salivary pooling and pharyngeal clearance, respectively) were strongly negatively correlated with a maximum hypopharyngeal pressure (r = -0.57, p = 0.002) and strongly positively correlated with peristaltic velocity (r = 0.53, p = 0.007), respectively. SR scores and Hyodo scores related to SR were not correlated with pressure data of the UES.
Manometric analysis of our SR scoring method using FEES revealed that a higher amount of SR in the valleculae, but not in the piriform sinuses, is associated with weaker pharyngeal pressure in pharyngeal dysphagia, especially at the oropharyngeal level.
4 Laryngoscope, 134:3519-3526, 2024.
在咽吞咽困难中，咽收缩不良和上食管括约肌（UES）功能障碍导致吞咽后唾液残留（SR）。本研究旨在通过吞咽功能纤维内镜评估（FEES）明确咽压与会厌谷和梨状隐窝吞咽后 SR 之间的关系。
纳入瓦伦贝格综合征患者。根据 FEES 上的 SR 评分，将会厌谷和梨状隐窝的吞咽后 SR 量分为四级。还计算了 Hyodo 评分以评估吞咽功能。获得高分辨率测压在鼻咽、口咽、下咽、口咽-下咽和 UES 区吞咽时的动力学数据，与 SR 和 Hyodo 评分进行比较。
在 31 名入组患者中，26 名成功接受 FEES 和测压的患者的数据进行了分析。会厌谷 SR 评分与口咽最大压力（r=-0.52，p=0.006）、口咽远端收缩积分（DCI）（r=-0.52，p=0.007）和口咽-下咽 DCI（r=-0.55，p=0.004）呈强负相关。参数 1 和 4（分别对应唾液淤积和咽部清除）的 Hyodo 评分与下咽部最大压力（r=-0.57，p=0.002）呈强负相关，与蠕动速度（r=0.53，p=0.007）呈强正相关。与 SR 相关的 SR 评分和 Hyodo 评分与 UES 的压力数据无关。
FEES 采用我们的 SR 评分方法进行的测压分析表明，会厌谷中 SR 量较高，而梨状隐窝中 SR 量较高与吞咽困难时咽压较弱有关，尤其是在口咽水平。
4 级，喉镜，134：3519-3526，2024.
