Bhowmick Nilanjan, Desai Vrushali, Rathinaswamy Rajasudhakar
Department of Laryngology, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Department of Speech-Language Sciences, All India Institute of Speech & Hearing, Mysore, India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5893-5898. doi: 10.1007/s12070-024-04979-z. Epub 2024 Sep 11.
The aim of the present study was three folds; (i) to correlate clinical case history with objective findings of a client presented with sternal discomfort along with odynophagia; (ii) to evaluate the cause for retrosternal discomfort using Functional Esophagoscopy (FE); and (iii) to reaffirm the Cook's (2008) algorithm for clinical diagnosis of esophageal dysphagia in single sitting using Transnasal Esophagoscopy (TNE). A 72 years old male (named 'G') visited a tertiary health care hospital with a complaint of imbalance for past 2 months. Also, had a complaint of pain while swallowing for the past 15 days along with left arm weakness (for past 2 days) and got admitted for treatment. Pertaining to swallowing, a detailed case history was taken and Fiber-optic endoscopic evaluation of swallowing (FEES) was performed to evaluate swallowing safety functions using digital swallowing workstation (KAYPENTAX, New Jersy, USA). A large growth was noticed in the lower border of esophagous using TNE in this patient. The oral, oro-pharyngeal, and pharyngeal phase of swallowing was intact. Esophageal phase of swallowing revealed reduced peristaltic movement including a mass lesion observed in client 'G' from TNE procedure. Clinical correlation of objective findings in this client corroborated well with history. Visualization studies including TNE can be used safely, comfortably in OPD basis without any anesthesia would be few advantages of TNE procedure. Even lesions at lower end of esophagus can be detected using TNE and it is concluded that the symptom retro-sternal discomfort might be clinically correlated with history and objectively determined by TNE procedure as esophageal dysphagia due to structural lesion. Also, algorithm of Cook's (2008) guides the investigation procedure quickly in a single sitting. Therefore, clinical history about patient is imperative that accurately guides further in terms of patient's care for assessment and treatment.
（i）将临床病例史与出现胸骨不适及吞咽痛的患者的客观检查结果相关联；（ii）使用功能性食管镜检查（FE）评估胸骨后不适的原因；（iii）再次确认库克（2008年）提出的通过经鼻食管镜检查（TNE）单次临床诊断食管吞咽困难的算法。一名72岁男性（名为“G”）因过去两个月的失衡问题前往一家三级医疗保健医院就诊。此外，他在过去15天有吞咽疼痛的症状，同时伴有左臂无力（过去2天），并入院接受治疗。关于吞咽，详细记录了病例史，并使用数字吞咽工作站（美国新泽西州凯宾泰克公司）进行了纤维光学吞咽内镜评估（FEES），以评估吞咽安全功能。通过TNE在该患者食管下边界发现一个大的肿物。吞咽的口腔、口咽和咽部阶段正常。吞咽的食管阶段显示蠕动运动减弱，包括在患者“G”的TNE检查中观察到的肿物病变。该患者客观检查结果与病史的临床相关性良好。包括TNE在内的可视化研究可以在门诊基础上安全、舒适地使用，无需任何麻醉，这是TNE检查的一些优点。即使食管下端的病变也可以通过TNE检测到，得出的结论是，胸骨后不适症状可能在临床上与病史相关，并通过TNE检查客观确定为结构性病变导致的食管吞咽困难。此外，库克（2008年）的算法可在单次检查中快速指导检查过程。因此，关于患者的临床病史对于准确指导患者护理的进一步评估和治疗至关重要。
