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[吞咽及吞咽障碍:耳鼻咽喉科的核心问题——从诊断到个体化治疗]

[Swallowing and swallowing disorders at the focus of otorhinolaryngology : From diagnosis to individualized treatment].

作者信息

Schwemmle Cornelia, Watt Niall, Arens Christoph

机构信息

Zentrum für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Giessen, Klinikstraße 33, 35392, Gießen, Deutschland.

出版信息

HNO. 2025 Apr 9. doi: 10.1007/s00106-025-01630-3.

Abstract

Dysphagia refers to painless impairment of the transport of liquid or solid food from the oral cavity to the stomach. If pain accompanies swallowing, this is termed odynophagia, and discomfort when swallowing saliva suggests a globus pharyngis. Swallowing disorders can occur during any one or all phases of bolus transport. The causes are manifold, due to the involvement of central control areas within the brain as well as the peripheral nervous system. The diagnosis consists of a detailed case history as well as screening forms and questionnaires. In Germany, the gold standard diagnostic procedure is flexible (video-)endoscopic evaluation of swallowing. Videofluoroscopy and electrophysiological examinations complement the diagnosis. Therapeutic options comprise functional strategies and rehabilitative exercises. However, the most important task of otorhinolaryngologists, in addition to the primary surgical treatment of tumors in the area of the upper swallowing tract (taking into account the preservation of swallowing structures), is the assessment of posttreatment dysphagia with the option of individualized surgical measures to improve swallowing.

摘要

吞咽困难是指液体或固体食物从口腔输送到胃的过程中出现无痛性障碍。如果吞咽时伴有疼痛,则称为吞咽痛,而吞咽唾液时的不适感提示有咽异感症。吞咽障碍可发生在食团输送的任何一个阶段或所有阶段。病因多种多样,这是由于大脑中的中枢控制区域以及周围神经系统均有涉及。诊断包括详细的病史以及筛查表格和问卷。在德国,金标准诊断程序是对吞咽进行灵活的(视频)内镜评估。视频荧光吞咽造影和电生理检查辅助诊断。治疗选择包括功能策略和康复训练。然而,耳鼻喉科医生最重要的任务,除了对上消化道区域的肿瘤进行初次手术治疗(同时考虑保留吞咽结构)外,是评估治疗后吞咽困难,并选择个体化的手术措施来改善吞咽。

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