Fiberoptic endoscopic findings of oropharyngeal swallowing of different food consistencies in Amyotrophic Lateral Sclerosis
Achados videoendoscópicos da deglutição em diferentes consistências de alimento na Esclerose Lateral Amiotrófica
Marina Mendes Gozzer; Paula Cristina Cola; Suely Mayumi Motonaga Onofri; Beatriz Novaes Merola; Roberta Gonçalves da Silva.
Abstract
Purpose: This study aimed to compare the fiberoptic endoscopic findings of oropharyngeal swallowing of distinct food consistencies in Amyotrophic Lateral Sclerosis (ALS). Methods: This was a retrospective clinical study of a convenience sample of 20 individuals (13 males and seven females aged 34 to 78 years old) with a diagnosis of ALS and oropharyngeal dysphagia confirmed by clinical and objective evaluation of swallowing, regardless of the bulbar or skeletal type and of the time of neurological diagnosis. The fiberoptic endoscopic evaluation of swallowing (FEES) of the liquid (N = 18), thickened liquid (N = 19) and pureed samples (N = 20) in a volume of 5 ml were analyzed. Data related to posterior oral spillage, pharyngeal residues, laryngeal penetration and/or aspiration after swallowing the three food consistencies were analyzed statistically by the Friedman ANOVA test. Results: No impairment of laryngeal sensitivity was found in this population. There was no statistically significant difference in posterior oral spillage, penetration and/or aspiration between food consistencies. There was a statistically significant difference only related to pharyngeal residues of the thickened liquid and pureed consistency. Conclusion: Among the fiberoptic endoscopic findings of swallowing in ALS, only pharyngeal residues had a higher frequency depending on the consistency of food.
Keywords
Resumo
Objetivo: Este estudo teve por objetivo comparar os achados videoendoscópicos da deglutição orofaríngea em distintas consistências de alimento na Esclerose Lateral Amiotrófica (ELA). Método: Estudo clínico retrospectivo com amostra de conveniência. Foram incluídos 20 indivíduos com diagnóstico de LAS e disfagia orofaríngea confirmada por avaliação clínica e objetiva de deglutição, independentemente do tipo, bulbar ou esquelética, e tempo de diagnóstico neurológico, 13 do sexo masculino e sete do sexo feminino, faixa etária variando de 34 a 78 anos, média de 57 anos. Foram analisados os achados da videoendoscopia de deglutição (VED) nas consistências líquida (N=18), líquida espessada (N=19) e pastosa (N=20) no volume de cinco ml. Os achados sobre escape oral posterior, resíduos faríngeos, penetração laríngea e/ou aspiração foram comparados nas três consistências de alimento e a análise estatística utilizou o teste ANOVA de Friedman. Resultados: Não foi encontrada alteração na sensibilidade laríngea nessa população. Não houve diferença estatística significativa entre as consistências de alimento na presença de escape oral posterior, penetração e/ou aspiração. Houve diferença estatística significativa somente com resíduos faríngeos na consistência líquida espessada e pastosa na ELA. Conclusão: Dentre os achados videoendoscópicos da deglutição na ELA, somente o resíduo faríngeo teve maior frequência na dependência da consistência de alimento.
References
1 Kawai S, Tsukuda M, Mochimatsu I, Enomoto H, Kagesato Y, Hirose H, et al. A study of the early stage of Dysphagia in amyotrophic lateral sclerosis. Dysphagia. 2003;18(1):1-8. http://dx.doi.org/10.1007/s00455-002-0074-3. PMid:12497190. [ Links ]
2 Remesso GC, Fukujima MM, Chiappetta ALML, Oda AL, Aguiar AS, Oliveira ASB, et al. Swallowing disorders after ischemic stroke. Arq Neuropsiquiatr. 2011;69(5):785-9. http://dx.doi.org/10.1590/S0004-282X2011000600012. PMid:22042182. [ Links ]
3 Hisashi S, Fukumitsu R, Ishida M, Nodera A, Otani T, Maruoka T, et al. Dysphagia in Parkinson’s disease. Rinsho Shinkeigaku. 2016;56(8):550-4. http://dx.doi.org/10.5692/clinicalneurol.cn-000871. PMid:27477577. [ Links ]
4 Wada A, Kawakami M, Liu M, Otaka E, Nishimura A, Liu F, et al. Development of a new scale for dysphagia in patients with progressive neuromuscular diseases:the Neuromuscular Disease Swallowing Status Scale (NdSSS). J Neurol. 2015;262(10):2225-31. http://dx.doi.org/10.1007/s00415-015-7836-y. PMid:26142025. [ Links ]
5 Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259-70. http://dx.doi.org/10.1038/nrgastro.2015.49. PMid:25850008. [ Links ]
6 Paik NJ, Kim SJ, Lee HJ, Jeon JY, Lim JY, Han TR. Movement of the hyoid boneand the epiglottis during swallowing in patients with dysphagia from different etiologies. J Electromyogr Kinesiol. 2008;18(2):329-35. http://dx.doi.org/10.1016/j.jelekin.2006.09.011. PMid:17187991. [ Links ]
7 Higo R, Tayama N, Nito T. Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis. Auris Nasus Larynx. 2004;31(3):247-54. http://dx.doi.org/10.1016/j.anl.2004.05.009. PMid:15364359. [ Links ]
8 Kühnlein P, Gdynia HJ, Sperfeld AD, Lindner-Pfleghar B, Ludolph AC, Prosiegel M, et al. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol. 2008;4(7):366-74. http://dx.doi.org/10.1038/ncpneuro0853. PMid:18560390. [ Links ]
9 Higo R, Tayama N, Watanabe T, Nitou T. Videomanofluorometric study in amyotrophic lateral sclerosis. Laryngoscope. 2002;112(5):911-7. http://dx.doi.org/10.1097/00005537-200205000-00024. PMid:12150627. [ Links ]
10 D’Ottaviano FG, Linhares TA Fo, Andrade HM, Alves PC, Rocha MS. Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis. Rev Bras Otorrinolaringol (Engl Ed). 2013;79(3):349-53. http://dx.doi.org/10.5935/1808-8694.20130061. PMid:23743751. [ Links ]
11 Murono S, Hamaguchi T, Yoshida H, Nakanishi Y, Tsuji A, Endo K, et al. Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis. Auris Nasus Larynx. 2015;42(3):213-7. http://dx.doi.org/10.1016/j.anl.2014.10.012. PMid:25466359. [ Links ]
12 ADA: American Dietetic Association. National dysphagia diet: standardization for optimal care. Chicago: ADA; 2002. [ Links ]
13 Gatto AR, Cola PC, Silva RG, Spadotto AA, Ribeiro PW, Schelp AO, et al. Sour taste and cold temperature in the oral phase of swallowing in patients after stroke. CoDAS. 2013;25(2):164-8. http://dx.doi.org/10.1590/S2317-17822013000200012. PMid:24408246. [ Links ]
14 Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):965-74. http://dx.doi.org/10.2214/ajr.154.5.2108570. PMid:2108570. [ Links ]
15 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8. http://dx.doi.org/10.1007/BF00417897. PMid:8721066. [ Links ]
16 Brandão BC, Galdino AS, Lourenção LG, Trindade GS, Silva MAOMD, Silva RGD. Correlation between bulbar functionality and laryngeal penetration and/or laryngotracheal aspiration on motor neuron disease. CoDAS. 2018;30(1):e20170056. PMid:29513871. [ Links ]
17 Park Y, Park J, Kim Y, Baek H, Kim SH. Association between nutritional status and disease severity using the amyotrophic lateral sclerosis (ALS) functional rating scale in ALS patients. Nutrition. 2015;31(11-12):1362-7. http://dx.doi.org/10.1016/j.nut.2015.05.025. PMid:26429656. [ Links ]
18 Tabor L, Gaziano J, Watts S, Robison R, Plowman EK. Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia. 2016;31(3):376-82. http://dx.doi.org/10.1007/s00455-015-9686-2. PMid:26837611. [ Links ]
19 Aviv JE, Spitzer J, Cohen M, Ma G, Belafsky P, Close LG. Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration. Laryngoscope. 2002;112(2):338-41. http://dx.doi.org/10.1097/00005537-200202000-00025. PMid:11889394. [ Links ]
20 Onofri SM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256-61. http://dx.doi.org/10.1007/s00455-013-9504-7. PMid:24442645. [ Links ]
21 Waito AA, Tabor-Gray LC, Steele CM, Plowman EK. Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS). Neurogastroenterol Motil. 2018;30(12):e13450. http://dx.doi.org/10.1111/nmo.13450. PMid:30129164. [ Links ]
22 Chen MYM, Ott DJ, Peele VN, Gelfand DW. Oropharynx in patients with cerebrovascular disease: evaluation with videofluoroscopy. Radiology. 1990;176(3):641-3. http://dx.doi.org/10.1148/radiology.176.3.2389021. PMid:2389021. [ Links ]
23 Teasell RW, Bach D, McRae M. Prevalence and recovery of aspiration poststroke: a retrospective analysis. Dysphagia. 1994;9(1):35-9. http://dx.doi.org/10.1007/BF00262757. PMid:8131423. [ Links ]
24 Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, et al. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand. 2013;128(6):397-401. http://dx.doi.org/10.1111/ane.12136. PMid:23668293. [ Links ]
25 Jani MP, Gore GB. Swallowing characteristics in Amyotrophic Lateral Sclerosis. NeuroRehabilitation. 2016;39(2):273-6. http://dx.doi.org/10.3233/NRE-161357. PMid:27372362. [ Links ]
26 Fattori B, Grosso M, Bongioanni P, Nacci A, Cristofani R, AlSharif A, et al. Assessment of swallowing by oropharyngoesophageal scintigraphy in patients with amyotrophic lateral sclerosis. Dysphagia. 2006;21(4):280-6. http://dx.doi.org/10.1007/s00455-006-9052-5. PMid:17221290. [ Links ]
27 Santos RR, Sales AV, Cola PC, Ribeiro PW, Jorge AG, Peres FM, et al. Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in stroke. CoDAS. 2014;26(3):231-4. http://dx.doi.org/10.1590/2317-1782/201420140476. PMid:25118920. [ Links ]
Submitted date:
09/25/2018
Accepted date:
04/26/2019