Establishment of screening method for diagnosing pharyngeal dysphagia during eating-Establishment of diagnosing criteria for cervical auscultation-

颈椎听诊(CA)常用于吞咽困难的临床评估。应用CA可将吞咽困难患者的呼吸、吞咽音与正常人区分开来。本研究旨在评估CA的准确性。我们在研究吞咽声音时遇到的问题之一是，由于我们使用了加速度计来检测吞咽声音，所以在检测到的声音和实际听诊的声音之间存在声音质量的差异。在这项研究中，我们开发了一种使用麦克风的吞咽声检测系统。研究对象为30例头颈部混合型癌症术后患者，给予知情同意。在VF检查中，用麦克风检测呼吸和吞咽声音，并用视频荧光(VF)图像记录到DV记录器中。编辑了30个声音样本，并通过耳机向8名考官展示。每个声音样本包括吞咽前的呼气声、吞咽5毫升钡时产生的吞咽声，以及吞咽后立即发出的呼气声。在没有视频荧光图像的情况下，每个审查员都在听觉上将声音样本判断为两种类型中的一种--安全吞咽或吞咽困难。为了评估颈部听诊的准确性，我们评估了听觉判断与VF图像的符合率，两类听诊与VF图像的符合率平均超过80%。这一结果表明CA作为临床诊断吞咽困难的工具是可靠的。

Cervical auscultation(CA) is frequently used for the clinical assessment of dysphagia. Using CA, respiratory and swallowing sounds of dysphagic patients can be distinguished from those of normal. This study was done to evaluate the accuracy of CA. One of the problems we had in studying swallowing sounds was that there was a difference in sound quality between detected sounds and actual auscultated sounds since we have used an accelerometer to detect swallowing sounds. In this study, we developed a swallowing sound detection system using a microphone. Thirty mixed head and neck post-surgical cancer patients, giving informed consent, served as subjects. During VF examination, respiratory and swallowing sounds were detected by a microphone and recorded to a DV recorder with videofluorographic(VF) images. Thirty sound samples were edited and presented to eight examiners through headphones. Each sound sample included expiratory sounds before swallow, swallowing sounds produced by 5ml barium swallow, and expiratory sounds immediately after swallow. Without videofluorographic images, each examiner auditorily judged the sound samples to one of two categories-safe swallow or dysphagic swallow. To evaluate the accuracy of cervical auscultation, we assessed the percent agreement of auditory judgement with Vf images.The percent agreement of two categories judged auditorily with VF images averaged over 80%. This result revealed the reliability of CA as a clinical tool for diagnosing dysphagic swallow.