词条 | Oropharyngeal dysphagia |
释义 |
| name = Oropharyngeal dysphagia | synonyms = | image = | caption = | pronounce = | field = Gastroenterology, ENT surgery | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper esophageal sphincter. Swallowing disorders can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions.[1] Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly,[2] in patients who have had strokes,[3] and in patients who are admitted to acute care hospitals or chronic care facilities. Other causes of dysphagia include head and neck cancer and progressive neurologic diseases like Parkinson's disease, Dementia, Multiple sclerosis, Multiple system atrophy, or Amyotrophic lateral sclerosis. Dysphagia is a symptom of many different causes, which can usually be elicited by a careful history by the treating physician. A formal oropharyngeal dysphagia evaluation is performed by a speech-language pathologist or occupational therapist.[4] Dysphagia is classified by the deficit area such as oral, pharyngeal, oropharyngeal and esophageal dysphagia. In some patients, no organic cause for dysphagia can be found, and these patients are defined as having functional dysphagia. Signs and symptomsSome signs and symptoms of swallowing difficulties include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty).[1] When asked where the food is getting stuck patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived. ComplicationsIf left untreated, swallowing disorders can potentially cause aspiration pneumonia, malnutrition, or dehydration.[1] Differential diagnosis
Assessment of adultsA swallowing assessment is typically done for dysphagia. During this initial examination a medical history is obtained, the mini-mental state examination is sometimes administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally. A patient needing further investigation will most likely receive a Modified Barium swallow (MBS). Different consistencies of liquid and food mixed with barium sulfate are fed to the patient by spoon, cup or syringe, and x-rayed using videofluoroscopy. A patient's swallowing then can be evaluated and described. Some clinicians might choose to describe each phase of the swallow in detail, making mention of any delays or deviations from the norm. Others might choose to use a rating scale such as the Penetration Aspiration Scale. The scale was developed to describe the disordered physiology of a person's swallow using the numbers 1-8.[6] Other scales also exist for this purpose. A patient can also be assessed using videoendoscopy, also known as flexible fiberoptic endoscopic examination of swallowing (FFEES). The instrument is placed into the nose until the clinician can view the pharynx and then he or she examines the pharynx and larynx before and after swallowing. During the actual swallow, the camera is blocked from viewing the anatomical structures. A rigid scope, placed into the oral cavity to view the structures of the pharynx and larynx, can also be used, though this prevents the patient from swallowing.[1] Other less frequently used assessments of swallowing are imaging studies, ultrasound and scintigraphy and nonimaging studies, electromyography (EMG), electroglottography (EGG)(records vocal fold movement), cervical auscultation, and pharyngeal manometry.[1] TreatmentAfter assessment, to determine the safety of the person's swallow and recommend treatment accordingly.
In order to strengthen muscles in the mouth and throat areas, researchers at the University of Wisconsin-Madison, led by Dr. JoAnne Robbins, developed a device in which patients perform isometric exercises with the tongue.[8]
Diet modification may be warranted. Some patients require a soft diet that is easily chewed, and some require liquids of a thinned or thickened consistency. The effectiveness of modifying food and fluid in preventing aspiration pneumonia has been questioned and these can be associated with poorer nutrition, hydration and quality of life.[9] There has been considerable variability in national approaches to describing different degrees of thickened fluids and food textures. However, the International Dysphagia Diet Standardisation Initiative (IDDSI) group produced an agreed IDDSI framework consisting of a continuum of 8 levels (0-7), where drinks are measured from Levels 0 – 4, while foods are measured from Levels 3 – 7.[10]
Environmental modification can be suggested to assist and reduce risk factors for aspiration. For example, removing distractions like too many people in the room or turning off the TV during feeding, etc.
Oral sensory awareness techniques can be used with patients who have a swallow apraxia, tactile agnosia for food, delayed onset of the oral swallow, reduced oral sensation, or delayed onset of the pharyngeal swallow.[1]
Electrical stimulation (E-stim) is targeted for oropharyngeal dysphagia and uses electrical stimulation to retrain the muscles used in swallowing and facilitate voluntary swallowing activity. This type of therapy has been used in a clinical setting for many years in Physical Therapy. Its use for oropharyngeal dysphagia has received much attention in recent years and is now the most researched treatment intervention in dysphagia therapy.
SurgeryThese are usually only recommended as a last resort.
References1. ^1 2 3 4 5 6 7 {{cite book |author=Logemann, Jeri A. |title=Evaluation and treatment of swallowing disorders |publisher=Pro-Ed |location=Austin, Tex |year=1998 |pages= |isbn=0-89079-728-5 |oclc= |doi=}} 2. ^{{cite journal | vauthors = Shamburek RD, Farrar JT | title = Disorders of the digestive system in the elderly | journal = The New England Journal of Medicine | volume = 322 | issue = 7 | pages = 438–43 | date = February 1990 | pmid = 2405269 | doi = 10.1056/NEJM199002153220705 }} 3. ^{{cite journal | vauthors = Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R | title = Dysphagia after stroke: incidence, diagnosis, and pulmonary complications | journal = Stroke | volume = 36 | issue = 12 | pages = 2756–63 | date = December 2005 | pmid = 16269630 | doi = 10.1161/01.STR.0000190056.76543.eb | url = http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=16269630 | doi-brokendate = }} 4. ^{{cite journal | vauthors = Ingelfinger FJ, Kramer P, Soutter L, Schatzki R | title = Panel discussion on diseases of the esophagus | journal = The American Journal of Gastroenterology | volume = 31 | issue = 2 | pages = 117–31 | date = February 1959 | pmid = 13617241 | doi = }} 5. ^1 2 3 4 5 Murray, J. (1999). Manual of Dysphagia Assessment in Adults. San Diego: Singular Publishing. 6. ^{{cite journal | vauthors = Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL | title = A penetration-aspiration scale | journal = Dysphagia | volume = 11 | issue = 2 | pages = 93–8 | year = 1996 | pmid = 8721066 | doi = 10.1007/BF00417897 }} 7. ^{{cite web |url=http://www.csuchico.edu/~pmccaffrey/syllabi/SPPA342/342unit7.html |title=The Remediation of Dysphagia at California State University, Chico |access-date=2008-02-23 |work=}} 8. ^{{cite web|url= http://www.swallowingdisorderfoundation.com/advances-in-swallowing-disorder-therapy/ |title= Advances in Swallowing Disorders Therapy |publisher=Swallowing Disorder Foundation |date= June 1, 2013|access-date=July 28, 2014}} 9. ^{{cite journal | vauthors = O'Keeffe ST | title = Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? | language = En | journal = BMC Geriatrics | volume = 18 | issue = 1 | pages = 167 | date = July 2018 | pmid = 30029632 | pmc = 6053717 | doi = 10.1186/s12877-018-0839-7 | url = https://doi.org/10.1186/s12877-018-0839-7 }} 10. ^{{cite journal | vauthors = Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S | title = Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework | journal = Dysphagia | volume = 32 | issue = 2 | pages = 293–314 | date = April 2017 | pmid = 27913916 | pmc = 5380696 | doi = 10.1007/s00455-016-9758-y | url = https://doi.org/10.1007/s00455-016-9758-y }} External links{{Medical resources| ICD10 = {{ICD10|R|13||r|10}} | ICD9 = {{ICD9|787.22}} | ICDO = | OMIM = | MedlinePlus = 003115 | eMedicineSubj = pmr | eMedicineTopic = 194 | DiseasesDB = 17942 | MeshID = D003680 }}
1 : Symptoms and signs: Digestive system and abdomen |
随便看 |
|
开放百科全书收录14589846条英语、德语、日语等多语种百科知识,基本涵盖了大多数领域的百科知识,是一部内容自由、开放的电子版国际百科全书。