Development of New Diagnostic Method for Detecting Swallowing Disorders

本研究旨在定量评估吞咽后的呼气音，作为区分吞咽困难与正常吞咽的方法。[对象与方法]对43例头颈癌术前、术后混合型患者进行回顾性分析。检查前，所有患者均被指示发出清晰的软呼气音（SES），无刺耳或湿呼吸。患者通过自主咳嗽清除喉部残余分泌物，直至能够发出SES。对于一些患者，需要吸痰来满足这个要求。患者多次吞入5ml钡（180%w/v）。使用我们的方法检测吞咽后的SES，并将这些吞咽和呼气事件的视频荧光图像（VE）输入VHS录像机。利用计算声学分析系统对SES的声信号进行分析，分别对250 Hz、500 Hz和1倍频段进行分析，得到0 ~ 4 kHz各频段的平均幅值。每个受试者评估5 - 7个SESs。【结果与结论】在VF数据中，无吸入法吞咽（SESwoAP）产生SESs 92例，有吸入法吞咽困难（SESwA）产生SESs 102例，有穿透法吞咽困难（SESwP）产生SESs 16例。seswa在0 ~ 1000 Hz波段的平均振幅显著大于seswoap （Mann- Whitney U检验p<01）。从0 ~ 250 Hz波段的SESs平均震级与VF数据（woAP/wA）的比较表明，这两个地区的SESs平均震级具有显著的一致性。敏感性为83.2%，特异性为82.6%，一致性为82.9%（临界幅度：26.0 dB）。这些结果支持使用SES作为检测误吸的临床工具。

This study was designed to evaluate quantitatively the expiratory sounds after swallows as a method for distinguishing dysphagic from normal swallows.[Subjects and Methods] Forty three mixed pre- and post-surgical head and neck cancer patients were examined. Before the examination, all patients were instructed to make clear soft expiratory sunds (SES) without harsh or wet breating. Patients cleared any residual secretions in the pharyngo-laryngeal region by voluntary cough until they could make SES.For some patients, suctioning was required to meet this requirement. Patients swallowed 5 ml of barium (180%w/v) several times. SES after the swallows were detected using our method and fed to a VHS video recorder with videofluorographic (VE) images of these swallows and expiratory events. Acoustic signals of SES were analyzed by our computed acoustic analyzing system to obtain an averaged magnitude of each frequency band from 0 to 4 kHz using the 250 Hz, 500 Hz and 1 octave band analyzes. Five to seven SESs were evaluated for each subject.[Results and Conclusions] From the VF data, 92 SESs were produced after the swallow without aspiration or penetration (SESwoAP), 102 SESs were produced after dysphagic swallows with aspiration (SESwA), and 16 SESs were produced after dysphagic swallows with penetration (SESwP). The averaged magnitudes from 0 to 1000 Hz bands of SESwAs were significantly greater than those of SESwoAPs (p<01 by Mann- Whitney U test). Comparison of the averaged magnitude from 0 to 250 Hz band of SESs with the VF data (woAP/wA) showed significant agreement in both areas. Sensitivity was 83.2%, specificity 82.6% and percent agreement was 82.9% (critical magnitude : 26.0 dB). These results support using SES as a clinical tool for detecting aspiration.