CONTEMPORARY DIAGNOSIS OF THE DYSPHAGIC PATIENT

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• 作者：Robert W. Bastian ; MD^*
• 刊名：Otolaryngologic Clinics of North America
• 出版年：1998
• 出版时间：1 June 1998
• 年：1998
• 卷：31
• 期：3
• 页码：489-506
• 全文大小：876 K

文摘

The diagnostic sequence used when working with a new patient with symptoms of dysphagia begins with a general medical history, followed by a focused history of the swallowing problem. Among the questions asked might be those pertaining to the chronology of the disorder, obvious causes if any, the effect of different food consistencies, other exacerbating or ameliorating influences, prior diagnoses and treatments, and patient perception of severity. The patient's symptoms/manifestations of dysphagia, such as coughing while eating or drinking, voice and speech changes, weight loss, and evidence of pneumonia also will be sought.

After this history taking comes a thorough examination of the head and neck. This will focus on the anatomic integrity of the upper aerodigestive tract and then move on to assessment of tongue, palate, pharynx, and larynx with respect to range of motion, and then to neurologic signs such as incoordination, fasciculations, tremor, and loss of sensation/gag/cough reflex.

An understanding of the problem may be emerging at this point, even though the patient's actual swallowing function has not been evaluated yet. In fact, at this point experienced workers already may be able to predict remarkably accurately the nature and severity of the swallowing disorder. This is particularly so when the patient context is one seen frequently before, as after partial laryngectomy. Obviously, however, speculation is inadequate for precise diagnosis and treatment. For this reason, some sort of swallowing study is appropriate to complete the work-up by revealing details of the patient's actual swallowing physiology. The clinician has several swallowing studies from which to choose. The list of possibilities here includes the barium swallow and its important derivative the videofluoroscopic swallowing study (VFSS, and , manometry, manofluorography (a combination of manometry and the VFSS), bolus scintigraphy, ultrasonography, and a new methodology, the videoendoscopic swallowing study (VESS) depicted in and .

Though not all workers will agree, VFSS and VESS would seem to head the list of these swallowing studies because they are currently the most generally available and useful. These two methods are described here only after first briefly describing the other less widespread options, with their advantages and disadvantages. Thereafter, the ¡°workhorse?tests, VFSS and VESS, will be explained in greater detail.