Relação entre queixa de dificuldade de deglutição e achados faríngeos em indivíduos com disfagia orofaríngea neurogênica
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2022-05-31
Autores
Santos, Bruna de Jesus
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Universidade Estadual Paulista (Unesp)
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Introdução: Em distintas doenças a queixa é fator determinante e pode contribuir como marcador para o rastreamento e diagnóstico precoces. Objetivo: Este estudo teve por objetivo relacionar a queixa de dificuldade de deglutição com achados faríngeos e comparar entre distintas doenças neurológicas em adultos. Método: Estudo clínico transversal observacional retrospectivo por amostra de conveniência. Para este estudo foram analisados 101 prontuários de indivíduos com doenças neurológicas, independente do sexo, idade ou tempo/estágio da doença, encaminhados a um Centro de Referência para o diagnóstico de disfagia orofaríngea. Foram excluídos os indivíduos com mais de uma etiologia de base, sem ambas avaliações clínica e videoendoscópica da deglutição e com ausência de queixas de deglutição. Foram incluídos 89 indivíduos com queixa de dificuldade de deglutição divididos em três grupos: grupo 1 composto por 40 indivíduos com Acidente Vascular Encefálico - AVE (G1), o grupo 2 por 30 indivíduos com Doença de Parkinson - DP (G2) e o grupo 3 composto por 19 indivíduos com Esclerose Lateral Amiotrófica - ELA (G3). As queixas de dificuldade de deglutição foram categorizadas em comprometimento da eficiência (C1), da segurança (C2) de deglutição ou de ambos concomitantemente (C3). Realizada videoendoscopia de deglutição com protocolo do serviço por meio de consistências e volume dos alimentos padronizados. As categorias e os tipos de queixa de deglutição foram relacionados com os achados de escape oral posterior, resíduos faríngeos e penetração/aspiração laringotraqueal entre os grupos. Realizada análise estatística por meio do Teste Qui-Quadrado. Resultados: As queixas de dificuldade de deglutição foram mais frequentes na categoria C3 independente do grupo. A queixa mais frequente na C1 foi dificuldade com a consistência dos alimentos em todos os grupos, na C2 a queixa de engasgo foi a mais frequente em todos os grupos e a C3 apresentou maior frequência de “uma queixa por categoria” no G1 e o G2 foi frequente “mais de uma queixa por categoria”, em G3 “uma queixa por categoria” e “mais de uma queixa por categoria” apresentaram mesma frequência. Houve relação entre categorias da queixa e escape oral posterior em todos os grupos. Ao comparar as categorias entre os grupos com os achados faríngeos houve associação entre C1 e C3 nos grupos G1 e G3, entre C2 e C3 no G2 para EOP. Não houve relação entre tipos de queixa com os achados faríngeos. Conclusão: As queixas de dificuldades de deglutição nos indivíduos Pós-AVE, com Doença de Parkinson ou com Esclerose Lateral Amiotrófica e disfagia orofaríngea foram mais frequentes na eficiência e segurança da deglutição concomitantemente. O escape oral posterior foi o único achado faríngeo presente em todas as categorias de queixa independentemente do grupo. Não houve diferença na relação entre os tipos das queixas de dificuldade de deglutição com os achados faríngeos entre os grupos.
Introduction: In different diseases, the complaint is a determining factor and can contribute as a marker for early screening and diagnosis. Objective: This study aimed to relate the complaint of swallowing difficulties with pharyngeal findings and to compare different neurological diseases in adults. Method: Retrospective, observational, cross-sectional clinical study using a convenience sample. For this study, 101 medical records of individuals with neurological diseases, regardless of sex, age or time/stage of the disease, referred to a Reference Center for the diagnosis of oropharyngeal dysphagia were analyzed. Individuals with more than one underlying etiology, without both clinical and videoendoscopic swallowing assessments and with no swallowing complaints were excluded. Eighty-nine individuals with complaints of swallowing difficulties were included, divided into three groups: group 1 composed of 40 individuals with cerebrovascular accident - CVA (G1), group 2 of 30 individuals with Parkinson's Disease - PD (G2) and group 3 composed of 19 individuals with Amyotrophic Lateral Sclerosis - ALS (G3). Complaints of difficulty in swallowing were categorized into impairment of efficiency (C1), safety (C2) of swallowing, or both concomitantly (C3). Swallowing videoendoscopy was performed with service protocol through standardized food consistencies and volume. The categories and types of swallowing complaints were related to the findings of posterior oral leak, pharyngeal residues and laryngotracheal penetration/aspiration between the groups. Statistical analysis was performed using the Chi-Square Test. Results: Complaints of swallowing difficulties were more frequent in category C3, regardless of the group. The most frequent complaint in C1 was difficulty with food consistency in all groups, in C2 the choking complaint was the most frequent in all groups and C3 had a higher frequency of "one complaint per category" in G1 and G2 “more than one complaint per category” was frequent, in G3 “one complaint per category” and “more than one complaint per category” presented the same frequency. There was a relationship between complaint categories and posterior oral leakage in all groups. When comparing the categories between the groups with the pharyngeal findings, there was a relationship between C1 and C3 in groups G1 and G3, between C2 and C3 in G2 for EOP. There was no relationship between types of complaint and pharyngeal findings. Conclusion: Complaints of swallowing difficulties in Post-CVA subjects, with Parkinson's Disease or with Amyotrophic Lateral Sclerosis and oropharyngeal dysphagia were more frequent in the efficiency and safety of swallowing concomitantly. Posterior oral leakage was the only pharyngeal finding present in all categories of complaints, regardless of the group. There was no difference in the relationship between the types of complaints of swallowing difficulties and pharyngeal findings between the groups.
Introduction: In different diseases, the complaint is a determining factor and can contribute as a marker for early screening and diagnosis. Objective: This study aimed to relate the complaint of swallowing difficulties with pharyngeal findings and to compare different neurological diseases in adults. Method: Retrospective, observational, cross-sectional clinical study using a convenience sample. For this study, 101 medical records of individuals with neurological diseases, regardless of sex, age or time/stage of the disease, referred to a Reference Center for the diagnosis of oropharyngeal dysphagia were analyzed. Individuals with more than one underlying etiology, without both clinical and videoendoscopic swallowing assessments and with no swallowing complaints were excluded. Eighty-nine individuals with complaints of swallowing difficulties were included, divided into three groups: group 1 composed of 40 individuals with cerebrovascular accident - CVA (G1), group 2 of 30 individuals with Parkinson's Disease - PD (G2) and group 3 composed of 19 individuals with Amyotrophic Lateral Sclerosis - ALS (G3). Complaints of difficulty in swallowing were categorized into impairment of efficiency (C1), safety (C2) of swallowing, or both concomitantly (C3). Swallowing videoendoscopy was performed with service protocol through standardized food consistencies and volume. The categories and types of swallowing complaints were related to the findings of posterior oral leak, pharyngeal residues and laryngotracheal penetration/aspiration between the groups. Statistical analysis was performed using the Chi-Square Test. Results: Complaints of swallowing difficulties were more frequent in category C3, regardless of the group. The most frequent complaint in C1 was difficulty with food consistency in all groups, in C2 the choking complaint was the most frequent in all groups and C3 had a higher frequency of "one complaint per category" in G1 and G2 “more than one complaint per category” was frequent, in G3 “one complaint per category” and “more than one complaint per category” presented the same frequency. There was a relationship between complaint categories and posterior oral leakage in all groups. When comparing the categories between the groups with the pharyngeal findings, there was a relationship between C1 and C3 in groups G1 and G3, between C2 and C3 in G2 for EOP. There was no relationship between types of complaint and pharyngeal findings. Conclusion: Complaints of swallowing difficulties in Post-CVA subjects, with Parkinson's Disease or with Amyotrophic Lateral Sclerosis and oropharyngeal dysphagia were more frequent in the efficiency and safety of swallowing concomitantly. Posterior oral leakage was the only pharyngeal finding present in all categories of complaints, regardless of the group. There was no difference in the relationship between the types of complaints of swallowing difficulties and pharyngeal findings between the groups.
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Palavras-chave
Deglutição, Transtornos de deglutição, Neurologia, Acidente vascular cerebral, Doença de Parkinson, Esclerose lateral amiotrófica, Swallowing, Swallowing disorders, Stroke, Parkinson disease, Amyotrophic lateral sclerosis
Como citar
SANTOS, Bruna de Jesus. Relação entre queixa de dificuldade de deglutição e achados faríngeos em indivíduos com disfagia orofaríngea neurogênica. Universidade Estadual Paulista (Unesp), 2022.