Aviv J E, Kim T, Thomson J E, Sunshine S, Kaplan S, Close L G
Department of Otolaryngology-Head and Neck Surgery, Columbia-Presbyterian Medical Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Dysphagia. 1998 Spring;13(2):87-92. doi: 10.1007/PL00009561.
The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.
本研究的目的是介绍一种吞咽运动和感觉成分的床旁评估新方法，即带感觉测试的纤维内镜吞咽评估（FEESST）。这种方法将已确立的床旁内镜吞咽评估与一种最近描述的技术相结合，该技术通过柔性内镜向喉上神经支配的黏膜输送空气脉冲刺激，从而客观地确定喉咽（LP）感觉辨别阈值。对20名健康对照受试者（平均年龄34±11岁）进行了FEESST的前瞻性研究。LP感觉阈值定义为正常（空气脉冲压力[APP]<4.0 mmHg）、中度缺陷（4.0 - 6.0 mmHg APP）或严重缺陷（>6.0 mmHg APP）。在LP感觉测试之后，给予不同稠度并混合绿色食用色素的食物，并关注溢出、喉穿透、咽部残留、误吸和反流情况。对每个受试者进行体位改变和气道保护技术等治疗操作，以确定评估的吞咽参数是否受操作影响。所有患者均完成研究；所有人的LP感觉辨别阈值均正常（2.9±0.7 mmHg APP）。没有溢出、喉穿透或误吸的情况。20名受试者中有2名有咽部残留，20名中有2名有反流。实施治疗操作导致喉咽解剖结构的内镜视野发生可预测的变化。FEESST可在床旁提供关于吞咽的全面、客观的感觉和运动信息，可能对吞咽困难患者的床旁诊断和管理有重要意义。
