Study design: Retrospective study. Objectives: Swallowing disorder in patients with tetraplegia represents a problem. Incidence and clinical data were examined to determine the influencing factors. Setting: Level I trauma Center, Berlin, Germany. Method: Retrospective study (1 September 1997-31 December 2002) on hospitalized patients with acute tetraplegia. The patients' swallowing ability was examined both clinically and endoscopically, and the results correlated with clinical data. Results: A total of 175 patients (144 (82.29%) male patients and 31 (17.71%) female patients (4.6:1) were studied. The peak age groups (43.45, ± 18.98, 14-89 years) were 20-30 years and over 60 years. C4-C6 were most commonly affected. Tetraplegia was trauma-related in 147 (84%) patients. Twentyeight (16.0%) patients appeared to be suffering from a swallowing disorder on first feeding, 23 (82.14%) patients with dysphagia were tracheotomized. The level of tetraplegia (w 2 ¼ 19.8; Po0.05), tracheotomy (w 2 ¼ 21.7; Po0.05) and the duration of ventilation (w 2 ¼ 24.84, Po0.05) were all found to be statistically significant factors in the development of a swallowing disorder. Age, surgical approach, level of tetraplegia, severity of paralysis and the need for tracheotomy were predictive of dysphagia in 73.14% patients. Five patients with dysphagia died (because of causes other than dysphagia) and 10 patients were discharged with a feeding tube. Conclusion: No single trigger for a swallowing disorder in acute tetraplegia was found. A combination of multiple factors (level of tetraplegia, severity of paralysis, tracheotomy, accompanying injuries and accompanying illnesses) restricts swallowing and compensation of changes, to the extent that a swallowing disorder becomes apparent.

Facio-oral tract therapy led to a statistically significant increase in alertness during the treatment session and, over the entire therapy period, to an increase in swallowing rate, alertness and swallowing ability. The decrease in alertness following therapy sessions must be taken into account in planning rehabilitative measures. Further studies on larger populations as well as studies currently in progress should further elucidate the strategies employed to rehabilitate dysphagic patients.

Contrary to clinical experience, clinical swallow tests are predominantly performed using water (water swallow tests, WST). In this study, we examine whether swallow tests performed using a bolus of semisolid food (bolus swallow test, BST) offer benefits. In a prospective, randomised, blind study, the results of a standardised saliva swallow test (SST), WST, BST, combinations of these tests and an endoscopic swallow test (FEES) in patients with oropharyngeal swallowing disorders of neurological (NEU) and non-neurological (NNEU) origin were compared. Sensitivity, specificity, test accuracy and inter-rater reliability were analysed. 62 patients (mean age = 64.68; range = 22–84) were included in the study (NEU = 40; NNEU = 22). A sensitivity of 70.7% (NEU = 70.3%, NNEU = 71.4%) and specificity of 82.5% (NEU = 92.3%; NNEU = 100%) were determined for the WST. The BST + SST was found to have a sensitivity of 89.6% (NEU = 66.7%; NNEU = 90.9%) and a specificity of 72.7% (NEU = 87.5%; NNEU = 90.9%). Analysis of test accuracy showed a statistically significant correlation between FEES and BST + SST. Only BST + SST exhibited statistically significant inter-rater reliability. BST in combination with SST was the sensitive clinical instrument for detecting aspiration both over the patient population as a whole and over the two sub-populations. Inter-rater reliability was found to be statistically significant. The results presented here demonstrate the benefit of semisolid food in investigating clinical dysphagia.

ZusammenfassungDie fiberoptische Untersuchung des Schluckens ist eine gut eingeführte Methode. Sie ist wegen ihrer Flexibilität insbesondere für die Verlaufskontrolle von Schluckstörungen geeignet. Für die Untersuchung stehen standardisierte Untersuchungsprotokolle zur Verfügung, die bisher noch nicht evaluiert wurden. Es wurde ein strukturierter Untersuchungsbogen entworfen, der zur Standardisierung der endoskopischen Schluckuntersuchung und deren Befundung genutzt werden soll. Gleichzeitig soll durch eine Indexierung der erhobenen Befunde der Versuch unternommen werden, die Auswertung der Untersuchungsergebnisse zu erleichtern und eine Klassifikation des Schweregrades der Schluckstörung zu ermöglichen. Der Untersuchungsbogen wurde in einer ersten Untersuchung auf seine Reliabilität und Reproduzierbarkeit untersucht. Die Reliabilität von 10 Untersuchungen lag bei 95 %, die Reproduzierbarkeit bei 4 Untersuchern und 10 Untersuchungen zwischen 90 % und 93 %. Der vorgestellte Untersuchungsbogen kann für die Befundung bei der endoskopischen Untersuchung von Schluckstörungen herangezogen werden. Im Weiteren wird eine multizentrische Studie die Therapieempfehlungen und Klassifikation der Schluckstörungen überprüfen. Schlüsselwörter Dysphagie´Endoskopie´Klassifikation´FEES AbstractThe endoscopic examination of swallowing is a well established method. Standardised examination protocols were not yet evaluated. We developed a standardised protocol to document the anatomical and functional findings after the specialised examination by videoendoscopy. The findings were transferred to a rating scale in order to assess the severity of disease. The examination protocol was examined on its intrarater and interrater agreement. The intrarater (95 %, N = 10) and interrater (90 % ± 93 %, 4 observers, N = 10) agreement indicates that the introduced examination protocol can be used for the documentation of endoscopic evaluation of swallowing. A multicentric study should now evaluate the suggested therapy recommendations and classification of dysphagia. Originalarbeit 28Heruntergeladen von: Universite Laval. Urheberrechtlich geschützt.