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，灵活的吞咽(费用)内窥镜评估已可用于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，费用并不是一种新的诊断工具；然而，新的是我们在健康参与者中评估的关于吞咽的试点数据的发现。令人惊讶的是，几乎没有关于“正常吞咽”的数据，以指导医疗保健提供者确定什么是“异常吞咽”。在我们的初步研究中，我们发现了出人意料的广泛的正常吞咽，这是以前没有报道过的，也是目前没有被认识到的。也就是说，我们在65名健康的老年参与者中发现，吞咽速度比预期的要慢，食物和液体残留在他们的喉咙里，并且发生了吸入(即食物或液体进入声带水平以下的呼吸道)。具体地说，在后一种观察中，我们发现19%的老年人在初步研究期间的某个时间点表现出渴望。因此，这个项目的主要目的是通过费用来检查正常参与者一生中的吞咽情况，以努力提供正常的准确定义，作为临床和研究领域异常吞咽的诊断基准。具体目的一是评估年龄、性别、推注类型、推注体积、推注粘度和推注给药方法对健康受试者吞咽的影响。吞咽将通过四个指标进行评估：1)穿透吸入量表(PAS)评分，2)咽反应持续时间，3)咽关闭持续时间，4)费用期间咽部残留。210名年龄在20岁至90岁之间的人将参加。我们的试验数据支持以下假设：在老年人中观察到更多的穿透和吸入事件，更长的咽部反应，更长的咽部关闭持续时间和更多的残留物。男性咽部闭合持续时间长于女性。剂量越大，穿透和吸入次数越多，咽部反应时间越长，咽部残留越大。渗透和吸入事件/分数受推注类型(例如，牛奶与水)和粘度(例如，稀液与浆状)的影响。为了进一步详细研究这些初步发现，提出了四个实验。具体目标二是确定四个吞咽参数在评分者内部和评价者之间的可靠性。9名临床医生将根据初始和短期(即一天)和长期(即一周)重复评级的函数来列出评分员内部的可靠性。评分者之间的可靠性将根据9名临床医生的临床内窥镜经验而获得(即，初级、中级和高级分别=10-100、101-1,000和1,001-10,000费用)。完成这两个目标将为正常参与者的吞咽及其费用评估的可靠性提供强有力的初步数据。这一探索性R03试点拨款的结果将指导R01拨款平台的分层需求，该平台将获得有关费用吞噬的广泛规范数据。 相关性：该项目的主要目的是通过灵活的吞咽内窥镜评估(费用)来检查健康参与者的吞咽情况。目前，临床医生和研究人员几乎没有关于正常吞咽的数据，以便准确诊断吞咽障碍并提出适当的饮食建议。这项研究得出的信息不仅将极大地提高吞咽障碍患者的诊断和临床护理水平，而且还将作为正常吞咽的基础数据，以建立R01赠款申请。

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.