Endoscopic Evaluation of Swallowing in Healthy Participants Across the Lifespan

描述（由申请人提供）：自大约1988年以来，已经有了灵活的吞咽内镜评估（FEES），以评估患者的吞咽功能并确定适当的口服摄入量。在这个阶段，FEES并不是一个新颖的诊断工具；然而，新颖的是我们在健康参与者中评估的吞咽试验数据的发现。令人惊讶的是，缺乏关于“正常吞咽”的数据来指导卫生保健提供者确定什么是“异常吞咽”。在我们的初步研究中，我们发现了出乎意料的大范围的正常吞咽，这是以前没有报道过的，也没有得到重视。也就是说，我们在65名健康的老年人参与者中发现，吞咽速度比预期的要慢，食物和液体残留在他们的喉咙里，并且出现误吸（即食物或液体进入声带以下的气道）。具体来说，在后一项观察中，我们发现19%的老年人在试点研究的某个时间点表现出误吸。因此，本项目的主要目的是通过FEES检查正常参与者在整个生命周期中的吞咽，努力提供正常的准确定义，以作为临床和研究领域诊断异常吞咽的基准。具体目的之一是评估年龄、性别、丸剂类型、丸剂体积、丸剂粘度和丸剂给药方式对健康参与者吞咽的影响。吞咽将通过四个指标进行评估：1)穿透吸入量表（PAS）评分，2)咽部反应持续时间，3)咽部闭合持续时间，4)咽部残留。210名20-90岁的人将参加。我们的试点数据支持以下假设：在老年人中观察到更多的渗透和误吸事件，更长的咽部反应，更长的咽部闭合持续时间和更大的残留。男性咽闭合时间比女性长。穿透和误吸的发生率更高，咽部反应时间更长，咽部残留也随着剂量的增加而增加。渗透和吸入事件/分数受丸剂类型（例如，牛奶vs水）和粘度（例如，稀液体vs泥）的影响。提出了四个实验来进一步详细研究这些初步发现。具体目的二是确定四个吞咽参数的内部和内部信度。评分者内部信度将由9位临床医生作为初始、短期（即一天）和长期（即一周）重复评分的函数制成表格。评级间的可靠性将作为九个临床医生内镜经验的函数获得，这些临床医生来自相等的平衡组（即，初级、中级和高级分别= 10-100、101-1,000和1001 -10,000）。完成这两个目标将为正常参与者的吞咽提供可靠的初步数据，并通过FEES评估其可靠性。这项探索性R03试点资助的结果将指导R01资助平台的分层需求，该平台将获得有关费用吞咽的广泛规范数据。

DESCRIPTION (provided by applicant): Flexible endoscopic evaluation of swallowing (FEES) has been available, since approximately 1988, to assess patient swallowing function and determine appropriate oral intake. At this stage, FEES is not a novel diagnostic tool; however, what is novel are the findings from our pilot data on swallowing as assessed in healthy participants. Surprisingly, scant data exist on "normal swallowing" to guide health care providers in determining what constitutes "abnormal swallowing." In our pilot studies, we found an unexpectedly broad range of normal swallowing that has not been previously reported or currently appreciated. That is, we found in 65 healthy older adult participants, slower swallowing than expected, food and liquid residue in their throats, and occurrences of aspiration (i.e., food or liquid enters the airway below the level of the vocal folds). Specifically, on the latter observation, we found that 19% of our older adults demonstrated aspiration at some point and time during the pilot studies. Accordingly, the primary aim of this project is to examine swallowing, via FEES, in normal participants across the life span in an effort to provide an accurate definition of normal to serve as a benchmark for the diagnoses of abnormal swallowing in both clinical and research realms. Specific aim one is to assess the effect of age, gender, bolus type, bolus volume, bolus viscosity, and bolus delivery method on swallowing in healthy participants. Swallowing will be assessed with four indices: 1) penetration aspiration scale (PAS) scores, 2) pharyngeal response duration, 3) pharyngeal closure duration, and 4) pharyngeal residue during FEES. Two hundred ten individuals, 20-90 years old will participate. Our pilot data support the following hypotheses: More penetration and aspiration events, longer pharyngeal response, longer pharyngeal closure duration, and greater residue are observed in older adults. Pharyngeal closure duration is longer in males than in females. Penetration and aspiration occurrences are greater, pharyngeal response times are longer, and pharyngeal residue is greater with larger boluses. Penetration and aspiration events/scores are affected by bolus type (e.g., milk vs. water) and viscosity (e.g., thin liquid vs. puree). Four experiments are proposed to further investigate these preliminary findings in detail. Specific aim two is to determine the intra-and inter-rater reliability of the four swallowing parameters. Intra-rater reliability will be tabulated from nine clinicians as a function of initial, and short- (i.e., one day) and long-term (i.e., one-week) repeat ratings. Inter-rater reliability will be acquired as a function of clinician endoscopic experience from nine clinicians of equal balanced groups (i.e., beginning, intermediate, and advanced = 10-100, 101-1,000, and 1,001-10,000 FEES performed, respectively). Completing these two aims will provide robust preliminary data on swallowing in normal participants and its reliability as assessed with FEES. The results of this exploratory R03 pilot grant will guide the stratification needs of a R01 grant platform that will obtain extensive normative data on swallowing with FEES. Relevance: The primary aim of this project is to examine swallowing, via Flexible Endoscopic Evaluation of Swallowing (FEES), in healthy participants across the life span. Currently, there is surprisingly little data on normal swallowing for clinicians and researchers to accurately diagnose swallowing disorders and make appropriate diet recommendations. The information derived from this study will not only serve to greatly enhance diagnosis and clinical care of patients with swallowing disorders but also serve as foundational data on normal swallowing of which to build a R01 grant application.