Dysphagia and aspiration with unilateral vocal cord immobility: Incidence, characterization, and response to surgical treatment
Dysphagia and aspiration with unilateral vocal cord immobility: Incidence, characterization, and response to surgical treatment
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DOI：
10.1177/000348940211100803
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发表时间：
2002-08-01
影响因子：
1.4
通讯作者：
Shapiro, J
中科院分区：
文献类型：
--
作者：
Bhattacharyya, N;Kotz, T;Shapiro, J
为了客观地确定与单侧声带不动（UVCI）相关的吞咽困难的发生率，并评估对声带内侧化反应的可能性，我们对新诊断的UVCI患者进行了视频透视吞咽（VFS）记录，并使用渗透-抽吸量表（PAS）和咽运输功能测量以盲法进行前瞻性分析。一部分患者接受了声带内侧化，并通过术后VFS研究进行了评价。比较术前和术后VFS结果，以研究声带内移在这种情况下的效果。对64例成人UVCI患者进行了87次VFS记录：23例患者在声带内侧化前后进行了VFS测试。UVCI最常见于左侧（53例），最常见于胸部或心脏手术（53.1%），其次是恶性肿瘤（15.6%）。总体而言，中位PAS评分为2.0（250;第75次评分，1.0-5.0），分别有20例患者（31.3%）和15例患者（23.4%）表现出渗透或抽吸。手术和非手术原因的瘫痪之间吞咽功能无显著差异（PAS评分分别为2.0和2.0，p = 0.901）。在接受声带内侧化手术（6例喉成形术和17例声带注射）后，研究患者的中位PAS评分从4.0改善至3.0（p = 395，Wilcoxon配对样本检验）。在解决误吸方面，喉成形术并不比声带注射更成功（p = 0.27）。影像学上明显的穿透或吸入发生在大约三分之一的UVCI患者中，与瘫痪的原因无关。声带内移术在消除这些患者的误吸方面可能不如想象的那么有效。
To objectively determine the incidence of dysphagia associated with unilateral vocal cord immobility (UVCI) and to evaluate the potential for response to vocal cord medialization, we made videofluoroscopic swallowing (VFS) recordings of patients with newly diagnosed UVCI and prospectively analyzed them in a blinded fashion using the Penetration-Aspiration Scale (PAS) and pharyngeal transport function measures. A subset of patients underwent vocal cord medialization and were evaluated with a postoperative VFS study. Comparison was made between preoperative and postoperative VFS results to study the effects of vocal cord medialization in this setting. Eighty-seven VFS recordings were studied in 64 adult patients with UVCI: 23 patient,, underwent VFS testing before and after vocal cord medialization. The UVCI was most commonly left-sided (53 cases) and most commonly resulted from thoracic or cardiac surgery (53.1%), followed by malignancy ( 15.6%). Overall, the median PAS score was 2,0 (250; 75th percentiles, 1.0-5.0), with 20 patients (31.3%) and 15 patients (23.4%) exhibiting penetration or aspiration, respectively. No significant differences in swallowing function were noted between surgical and nonsurgical causes of paralysis (PAS scores of 2.0 and 2.0, respectively p = .901). The median PAS score improved from 4.0 to 3.0 (p = 395, Wilcoxon paired samples test) in patients studied after undergoing a vocal cord medialization procedure (6 laryngoplasties and 17 vocal cord injections), Laryngoplasty was not more successful than vocal cord injection in resolving aspiration (p = .27). Radiographically significant penetration or aspiration occurs in approximately ore third of patients with UVCI, independent of the cause of paralysis. Vocal cord medialization may not be as effective as thought for eliminating aspiration in these patients.