Contribuição da ausculta cervical para a avaliação clínica das disfagia orofaríngeas

Abstract

Grants: CAPES/ CNPq.Conflict of interest: non-existent allows the speech therapist to identify: the difficulties the patient displays in the swallowing process, signs of laryngeal penetration and/or laringo-tracheal aspiration of the food swallowed, security in the maintenance or reintroduction of food orally, the best consistency to be used and the possible causes of the alterations identifiedDuring clinical assessment, it is observed the efficiency of the food bolus capture and preparation, the number of swallows, laryngeal elevation, the presence of coughing, choking or other suggestive signs of laryngeal penetration or laryngo-tracheal aspiration, oral escape of the food and nasal regurgitation, length of feeding, the presence of food residues in the oral cavity and changes in vocal quality after deglutition, as well as the need of using postural and/or facilitator maneuvers. To help in this process, most of speech therapists adopt instrumental resources such as the pulse oximetry and cervical auscultation [1][2][3][4] . ABSTRACTIn order to assist on the functional assessment of swallowing, most speech therapists make use of instrumental resources such as cervical auscultation. Thus, the objective of this study was to search the literature in order to find the contribution of cervical auscultation for assessing dysphagias. To this end, international and national journals were reviewed. These journals were indexed in Springer, Lilacs, Bireme, Medline and Scielo databases, comprising the period between 1992 and 2011. From the analysis of the studies, it was possible to verify that: cervical auscultation has been modernized with the technologic evolution, enabling the realization of quantitative studies of the swallowing sounds; there are still few clear evidence of the connections between the sound components of swallowing and the physiological events of the pharyngeal phase; no differences were observed between the swallowing sounds in children and adults; in some studies, cervical auscultation was positively correlated with the videofluoroscopic assessment of swallowing, and others presented positive correlation between these two assessment procedures. Hence, considering that the swallowing videofluoroscopy examination is still difficult to access, with relatively high cost, it is believed that cervical auscultation constitutes an important resource for the diagnosis and clinical monitoring in cases of oropharyngeal dysphagia.

Critérios fonoaudiológicos para indicação de via alternativa de alimentação em unidade de terapia intensiva em um hospital universitário

“…A paper containing 514 elderly attended at a reference center got a prevalence of 27.3% of communication disorders and 26.4% of swallowing possible intake of meal through the inferior by-air intake, since swallowing involves specific sounds 18,19 .…”

“…The researches still remain controversial as to the efficiency of cervical auscultating, for, although a quick, noninvasive and low cost method, its interpretation depends on the examiner's experience. In addition, it is not possible to quantity feeding stasis or food intakes 18 .…”

Comparação entre avaliação clínica e objetiva da deglutição na suspeita de aspiração silente

“…As alterações de deglutição são manifestações comuns no AVC e nosso estudo corroborou com a literatura ao mostrar incidência de disfagia com variação de 40% a 49% a depender da avaliação (DANIELLS et al, 2000;SCHELP et al, 2004;MARTINO et al, 2005;GATTO e REDHER, 2006;SINGH e HAMDY, 2006;MARTINO;MARTIN;BLACK, 2012;MOURÃO et al, 2016aMOURÃO et al, , 2016bPASSOS et al, 2017 Na literatura, os autores ainda divergem sobre a real utilidade da ausculta cervical na investigação de penetração e aspiração laringotraqueal, por ser uma análise subjetiva, por necessitar de treinamento e não estabelecer concordância entre os investigadores (LESLIE et al, 2007;FONTOURA, 2009). Outros, defendem seu uso como método complementar na avaliação clínica (BOOR et al, 2007;BOLZAN et al, 2013;FERRUCCI et al, 2013).…”

“…Em uma revisão bibliográfica sobre o assunto concluiu-se que embora haja poucas evidências sobre os sons da deglutição, sons disfágicos e sua correlação com alterações fisiológicas, há correlação positiva entre ausculta cervical e VFD (BOLZAN et al, 2013). Acredita-se que em centros que não há a VFD para comprovação de diagnóstico, sua utilização é de grande valia (BOLZAN et al, 2013;FERRUCCI et al, 2013).…”

“…A ausculta cervical é outro recurso instrumental não invasivo, de baixo custo, que juntamente com a oximetria de pulso, vem sendo utilizada na clínica fonoaudiológica. É uma técnica que consiste em ouvir os sons da respiração e deglutição durante a fase faríngea utilizando instrumentos de amplificação, como o estetoscópio e tem por objetivo sinalizar alteração da deglutição podendo, portanto, identificar pacientes com alto risco de penetração e/ou aspiração laríngea (BORR; HIELSCHER-FASTABEND;LUCKING, 2007;BOLZAN et al, 2013;FERRUCCI et al, 2013).…”