Saito K
Department of Otolaryngology, School of Medicine, Kanazawa University.
Nihon Jibiinkoka Gakkai Kaiho. 1995 Jul;98(7):1154-63. doi: 10.3950/jibiinkoka.98.1154.
There are many patients who complain of abnormal sensations, such as an obstructive sensation, foreign body sensation, difficulty in swallowing, etc., in the throat, which do not have an obvious cause. The causes of such unpleasant symptoms have not been adequately investigated. As one of the potential factors in volved in abnormal sensations in the throat, we considered the existence of subclinical dysphagia. We then performed videofluoroscopic analysis in patients with an abnormal sensation in the throat to examine whether or not there were functional disorders in swallowing. Videofluoroscopy was performed in 42 subjects, 30 patients with abnormal sensation in the throat and 12 volunteers without swallowing problems. We devised a temporal and spatial analysis system of swallowing using personal computer technology. Videofluoroscopic swallowing sequences during spoon feeding (3-5ml) and drinking from a cup (15-20ml) of liquid barium, were analyzed. The results suggest that two temporal measurements of swallow from videofluoroscopic studies are appropriate for parameter of subclinical dysphagia: the time it takes the bolus to move through pharynx from the point at which the bolus head passes the tongue base until the bolus head extends caudally beyond the piriform sinus while feeding from a spoon (S2), and the time it takes the bolus to move through the upper esophagus from the point at which the bolus head passes the bottom of the piriform sinus until the bolus tail passes the same point while drinking from a cup (C1). Then, we selected C1 and S2 for variables and detect the patients who have subclinical dysphagia with cluster analysis. Forty-two subjects were divided into two groups: those composed of 14 patients (cluster 1), and those composed of 16 patients and 12 controls (cluster 2). We thought 14 patients in cluster 1 would have subclinical dysphagia for the cause of abnormal sensation in the throat. Temporal and spatial analysis revealed three forms of pharyngeal swallow in cluster 1. In 6 patients, the bolus stall in the valleculae prior to the onset of the pharyngeal swallow. In other 6 patients, the bolus stall in the piriform sinus before swallowing reflex. In the other 2 patients, the bolus moved smoothly but slowly without delay in pharynx. Our results indicate that a delayed swallowing reflex is the main functional finding in videofluoroscopy in patients with subclinical dysphagia contributing to an abnormal sensatin in the throat.
有许多患者抱怨喉咙出现异常感觉，如梗阻感、异物感、吞咽困难等，且没有明显病因。此类不适症状的病因尚未得到充分研究。作为喉咙异常感觉的潜在因素之一，我们考虑了亚临床吞咽困难的存在。然后，我们对有喉咙异常感觉的患者进行了视频荧光吞咽分析，以检查吞咽功能是否存在障碍。对42名受试者进行了视频荧光吞咽检查，其中30名有喉咙异常感觉的患者和12名无吞咽问题的志愿者。我们利用个人计算机技术设计了一种吞咽的时间和空间分析系统。分析了用勺子喂食（3 - 5毫升）和从杯子中饮用（15 - 20毫升）液体钡剂时的视频荧光吞咽序列。结果表明，视频荧光吞咽研究中的两个吞咽时间测量值适合作为亚临床吞咽困难的参数：从食团头部通过舌根到食团头部向尾侧延伸超出梨状窦时，食团在喂食勺子时通过咽部所需的时间（S2），以及从食团头部通过梨状窦底部到食团尾部通过同一位置时，食团在从杯子中饮水时通过上食管所需的时间（C1）。然后，我们选择C1和S2作为变量，通过聚类分析检测出有亚临床吞咽困难的患者。42名受试者被分为两组：一组由14名患者组成（聚类1），另一组由16名患者和12名对照组成（聚类2）。我们认为聚类1中的14名患者因喉咙异常感觉而患有亚临床吞咽困难。时间和空间分析揭示了聚类1中咽部吞咽的三种形式。6名患者中，食团在咽部吞咽开始前滞留在会厌谷。另外6名患者中，食团在吞咽反射前滞留在梨状窦。另外2名患者中，食团移动顺畅但缓慢，在咽部无延迟。我们的结果表明，吞咽反射延迟是亚临床吞咽困难患者视频荧光吞咽检查中的主要功能表现，这导致了喉咙的异常感觉。
