Department of Otolaryngology, Iwate Prefectural Iwai Hospital, Ichinoseki, Iwate, Japan.
Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
PLoS One. 2024 Jul 11;19(7):e0305560. doi: 10.1371/journal.pone.0305560. eCollection 2024.
Swallowing dysfunction and the risk of aspiration pneumonia are frequent clinical problems in the treatment of head and neck squamous cell carcinomas (HNSCCs). Breathing-swallowing coordination is an important factor in evaluating the risk of aspiration pneumonia. To investigate breathing-swallowing discoordination after chemoradiotherapy (CRT), we monitored respiration and swallowing activity before and after CRT in patients with HNSCCs.
Non-invasive swallowing monitoring was prospectively performed in 25 patients with HNSCCs treated with CRT and grade 1 or lower radiation-induced dermatitis. Videoendoscopy, videofluoroscopy, Food Intake LEVEL Scale, and patient-reported swallowing difficulties were assessed.
Of the 25 patients selected for this study, four dropped out due to radiation-induced dermatitis. The remaining 21 patients were analyzed using a monitoring system before and after CRT. For each of the 21 patients, 405 swallows were analyzed. Swallowing latency and pause duration after the CRT were significantly extended compared to those before the CRT. In the analysis of each swallowing pattern, swallowing immediately followed by inspiration (SW-I pattern), reflecting breathing-swallowing discoordination, was observed more frequently after CRT (p = 0.0001). In 11 patients, the SW-I pattern was observed more frequently compared to that before the CRT (p = 0.00139). One patient developed aspiration pneumonia at 12 and 23 months after the CRT.
The results of this preliminary study indicate that breathing-swallowing discoordination tends to increase after CRT and could be involved in aspiration pneumonia. This non-invasive method may be useful for screening swallowing dysfunction and its potential risks.
吞咽功能障碍和吸入性肺炎的风险是头颈部鳞状细胞癌（HNSCC）治疗中的常见临床问题。呼吸-吞咽协调是评估吸入性肺炎风险的一个重要因素。为了研究放化疗（CRT）后呼吸-吞咽不协调的情况，我们对 HNSCC 患者进行了 CRT 前后的呼吸和吞咽活动监测。
对 25 例接受 CRT 治疗且 1 级或以下放射性皮炎的 HNSCC 患者进行了非侵入性吞咽监测。进行了视频内镜、视频透视、食物摄入水平量表和患者报告的吞咽困难评估。
在本研究中选择的 25 例患者中，有 4 例因放射性皮炎而退出。剩余的 21 例患者使用 CRT 前后的监测系统进行了分析。对于 21 例患者中的每例患者，分析了 405 次吞咽。与 CRT 前相比，CRT 后的吞咽潜伏期和停顿时间明显延长。在每种吞咽模式的分析中，更频繁地观察到吞咽后紧接着吸气（SW-I 模式），反映出呼吸-吞咽不协调，这在 CRT 后更为明显（p = 0.0001）。与 CRT 前相比，11 例患者 SW-I 模式更为常见（p = 0.00139）。一名患者在 CRT 后 12 个月和 23 个月时发生了吸入性肺炎。
本初步研究的结果表明，CRT 后呼吸-吞咽不协调倾向于增加，可能与吸入性肺炎有关。这种非侵入性方法可能有助于筛查吞咽功能障碍及其潜在风险。
