Correlação entre aspiração laringotraqueal, resíduos faríngeos e escape oral posterior na disfagia orofaríngea neurogênica
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2019-04-22
Autores
Merola, Beatriz Novais [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A disfagia orofaríngea neurogênica possui etiologias distintas e a aspiração laringotraqueal é considerada achado de risco co-dependente da sincronia entre vários fatores presentes na biomecânica da deglutição. Objetivo: Este estudo teve por objetivo correlacionar a penetração e/ou aspiração laringotraqueal com resíduos faríngeos e escape oral posterior na disfagia orofaríngea e comparar entre doenças neurológicas distintas. Método: Estudo clínico transversal. Realizada por dois juízes independentes a análise de 74 exames de nasoendoscopia de deglutição de indivíduos com diagnóstico de disfagia orofaríngea por doenças neurológicas distintas como Acidente Vascular Cerebral (AVC), Esclerose Lateral Amiotrófica (ELA) e Doenças de Parkinson (DP), independente do sexo, faixa etária de 32 a 96 anos e média de 65,53 anos. Para análise dos resultados os exames foram divididos em três grupos: o grupo 1 (G1) constou de 41 indivíduos com AVC (média de 68,75 anos), o grupo 2 (G2) de 16 com ELA (média de 57,18 anos) e o grupo 3 (G3) de 17 com DP (média de 72,52 anos). Realizada nasoendoscopia de deglutição nas consistências pastosa, líquida espessada e líquida, no volume de 5 ml, ofertados de uma a três vezes em colher. Para análise dos achados foi aplicada a Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), a Penetration Aspiration Scale (PAS) e foi elaborada escala para mensurar escape oral posterior (EOP) com análise da primeira deglutição e da deglutição considerada ineficiente. Realizada concordância entre juízes por meio do Coeficiente de Concordância Kappa obtendo-se concordância que variou de moderada a forte. Aplicado teste de correlação de Spearman. Resultado: Na primeira deglutição foi encontrado correlação entre PAS e resíduos em seios piriformes (YPRSRSps) no G1 e entre PAS e resíduos em valécula (YPRSRSv) no G2. Na deglutição ineficiente houve correlação no G1 entre PAS e YPRSRSps, PAS e resíduos em valécula somados aos seios piriformes (YPRSRSv+ps) e PAS e número de deglutições. No G2 foi encontrada correlação entre PAS e YPRSRSv e PAS e YPRSRSv+ps. Não foi encontrada nenhuma correlação entre as variáveis no G3. Não foi encontrada correlação entre PAS e EOP. Conclusão: Houve correlação entre aspiração e resíduos faríngeos, porém essa relação foi dependente da etiologia da disfagia orofaríngea neurogênica e em qual deglutição a análise foi realizada.
Introduction: Neurogenic oropharyngeal dysphagia has different etiologies, and laryngotracheal aspiration is considered a risk finding that is co-dependent on the synchrony between several factors present in swallowing biomechanics. Purpose: The aim of this study was to correlate the laryngotracheal aspiration with pharyngeal residues and posterior oral spillage in oropharyngeal dysphagia and to compare different neurological diseases. Method: Cross-sectional clinical study. Two independent judges performed the analysis of 74 fiberoptic endoscopic examinations of swallowing (FEES) of individuals with diagnosis of oropharyngeal dysphagia due to different neurological diseases such as Cerebrovascular Accident (CVA), Amyotrophic Lateral Sclerosis (ALS) and Parkinson's Disease (PD), regardless of sex, ranging from 32 to 96 years old and mean of 65.53 years old. For the analysis of the results the exams were divided into three groups: group 1 (G1) consisted of 41 individuals with CVA (average of 68,75 years), group 2 (G2) of 16 with ALS (average of 57,18 years), and group 3 (G3) of 17 with PD (average of 72,52 years). FES was performed in in paste, liquid thickened and liquid, in the volume of 5 ml, offered one to three times in a spoon. To analyze the findings was applied the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration Aspiration Scale (PAS) was developed and a scale was used to measure posterior oral spillage (POS) with analysis of the first swallowing and deglutition considered inefficient. Agreement between judges was made through the Kappa Concordance Coefficient obtaining agreement that ranged from moderate to strong. Applied Spearman's correlation test. Results: In the first swallow, correlation was found between PAS and residues in pyriform sinuses (YPRSRSps) in G1 and between PAS and residues in vallecula (YPRSRSv) in G2. In the ineffective swallowing there was correlation in G1 between PAS and YPRSRSps, PAS and vallecula residuals added to the pyriform sinuses (YPRSRSv+ps) and PAS and number of swallows. In G2 correlation was found between SBP and YPRSRSv and PAS and YPRSRSv+ps. No correlation was found between the variables in G3. No correlation was found between PAS and POS. Conclusion: There was a correlation between aspiration and pharyngeal residues, but this relation was dependent on the etiology of neurogenic oropharyngeal dysphagia and in which swallowing the analysis was performed.
Introduction: Neurogenic oropharyngeal dysphagia has different etiologies, and laryngotracheal aspiration is considered a risk finding that is co-dependent on the synchrony between several factors present in swallowing biomechanics. Purpose: The aim of this study was to correlate the laryngotracheal aspiration with pharyngeal residues and posterior oral spillage in oropharyngeal dysphagia and to compare different neurological diseases. Method: Cross-sectional clinical study. Two independent judges performed the analysis of 74 fiberoptic endoscopic examinations of swallowing (FEES) of individuals with diagnosis of oropharyngeal dysphagia due to different neurological diseases such as Cerebrovascular Accident (CVA), Amyotrophic Lateral Sclerosis (ALS) and Parkinson's Disease (PD), regardless of sex, ranging from 32 to 96 years old and mean of 65.53 years old. For the analysis of the results the exams were divided into three groups: group 1 (G1) consisted of 41 individuals with CVA (average of 68,75 years), group 2 (G2) of 16 with ALS (average of 57,18 years), and group 3 (G3) of 17 with PD (average of 72,52 years). FES was performed in in paste, liquid thickened and liquid, in the volume of 5 ml, offered one to three times in a spoon. To analyze the findings was applied the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration Aspiration Scale (PAS) was developed and a scale was used to measure posterior oral spillage (POS) with analysis of the first swallowing and deglutition considered inefficient. Agreement between judges was made through the Kappa Concordance Coefficient obtaining agreement that ranged from moderate to strong. Applied Spearman's correlation test. Results: In the first swallow, correlation was found between PAS and residues in pyriform sinuses (YPRSRSps) in G1 and between PAS and residues in vallecula (YPRSRSv) in G2. In the ineffective swallowing there was correlation in G1 between PAS and YPRSRSps, PAS and vallecula residuals added to the pyriform sinuses (YPRSRSv+ps) and PAS and number of swallows. In G2 correlation was found between SBP and YPRSRSv and PAS and YPRSRSv+ps. No correlation was found between the variables in G3. No correlation was found between PAS and POS. Conclusion: There was a correlation between aspiration and pharyngeal residues, but this relation was dependent on the etiology of neurogenic oropharyngeal dysphagia and in which swallowing the analysis was performed.
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Palavras-chave
Transtorno de deglutição, Deglutição, Aspiração respiratória, Avaliação, Endoscopia, Deglutition disorder, Deglutition, Respiratory aspiration, Evaluation, Endoscopy