Oropharyngeale Dysphagien – ein Update Teil 1: Physiologie, Pathologie und Diagnostik

Zusammenfassung

Schlucken ist ein komplexer Vorgang, der das koordinierte Zusammenspiel von verschiedenen Nerven und Muskelgruppen erfordert. Bei Fehlfunktionen können daraus oropharyngeale Dysphagien resultieren, die eine hohe Prävalenz – vor allem bei alten Menschen haben. Differenzialdiagnostisch kommen viele Ursachen infrage. Neben daraus resultierenden Einschränkungen in der Nahrungsaufnahme von bestimmten Konsistenzen können sich auch schwerwiegende Folgen, wie z. B. eine komplette nicht-orale Ernährung über eine PEG ergeben. Eine therapiesteuernde Diagnostik z. B. durch eine flexibel transnasale oder starre Videoendoskopie ist erforderlich, um die geeignete Behandlungsform zu finden, die häufig interdisziplinäre Aspekte beinhaltet.

Abstract

Update Oropharyngeal Dysphagia Part1: Physiology, Pathology and Diagnosis

Swallowing is a complex mechanism with many muscles and nerves needed. If this is disturbed, oropharyngeal dysphagia may be caused, especially in the elderly. There is a wide range of causes. Where oral feeding is sufficiently impaired then this route may have to be bypassed by percutaneous enteral gastostomy. Evaluation of swallowing is usually done with a fiberoptic or 90-degree optic. Individual needs must be addressed, usually, and best, by a multidisciplinary team.

Schlüsselwörter

Schlucken - Dysphagie - Aspiration

Key words

swallowing - dysphagia - aspiration

• Literatur

• 1 Dodds WJ. Physiology of swallowing. Dysphagia 1989; 3 (04) 171-178
• 2 Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol 1999; 277: 219-225
• 3 Hamdy S, Rothwell JC, Brooks DJ, Bailey D, Aziz Q, Thompson DG. Identification of the cerebral loci processing human swallowing with H2(15)O PET activation. J Neurophysiol 1999; 81 (04) 1917-1926
• 4 Riecker A, Gastl R, Kühnlein P, Kassubek J, Prosiegel M. Dysphagia due to unilateral infarction in the vascular territory of the anterior insula. Dysphagia 2009; 24 (01) 114-118
• 5 Lang IM. Brain stem control of the phases of swallowing. Dysphagia 2009; 24 (03) 333-348
• 6 Prosiegel M, Höling R, Heintze M, Wagner-Sonntag E, Wiseman K. The localization of central pattern generators for swallowing in humans – a clinical-anatomical study on patients with unilateral paresis of the vagal nerve, Avellis’ syndrome, Wallenberg’s syndrome, posterior fossa tumours and cerebellar hemorrhage. Acta Neurochir Suppl 2005; 93: 85-88
• 7 Kumar S. Swallowing and dysphagia in neurological disorders. Rev Neurol Dis 2010; 7: 19-27
• 8 Prosiegel M. Neurogenic Dysphagia. Nervenarzt 2007; 78 (10) 1209-1215
• 9 http://www.ncbi.nlm.nih.gov/pubmed/term=dysphagia
• 10 Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 2007; 116 (11) 858-865
• 11 Achem SR, Devault KR. Dysphagia in aging. J Clin Gastroenterol 2005; 39 (05) 357-371
• 12 Finiels H, Strubel D, Jacquot JM. Deglutition disorders in the elderly. Epidemiological aspects. Presse Med 2001; 30 (33) 1623-1634
• 13 Statistisches Bundesamt Deutschland 2009 http://www.destatis.de
• 14 Schröter-Morasch H. Schlucken. In: Lehrebuch der Phoniatrie und Pädaudiologie von. Wendler J, Seidner W, Eysholdt U. Thieme Verlag Stuttgart; 4. Auflage S. 337
• 15 Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL. Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev 2006; 43 (03) 301-310
• 16 Lim SH, Lieu PK, Phua SY, Seshadri R, Venketasubramanian N, Lee SH, Choo PW. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 2001; 6 (01) 1-6
• 17 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2 (04) 216-219
• 18 Hacki T, Kramer H, Kleinjung C, Pérez-Alvarez C, Schmid J. Endoscopic multi-color deglutition study. Laryngorhinootologie 2001; 80 (06) 335-340
• 19 Schindler A, Ginocchio D, Peri A, Felisati G, Ottaviani F. FEESST in the rehabilitation of dysphagia after partial laryngectomy. Ann Otol Rhinol Laryngol 2010; 119 (02) 71-76
• 20 Aviv JE, Kaplan ST, Thomson JE, Spitzer J, Diamond B, Close LG. The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia 2000; 15 (01) 39-44
• 21 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996; 11 (02) 93-98
• 22 Palmer JB, Kuhlemeier KV, Tippett DC, Lynch C. A protocol for the videofluorographic swallowing study. Dysphagia 1993; 8 (03) 209-214
• 23 Hannig C, Wuttge-Hannig A, Hess U. Analysis and radiologic staging of the type and severity of aspiration. Radiologe 1995; 35 (10) 741-746
• 24 Bauer F, Seiss M, Grässel E, Stelzle F, Klotz M, Rosanowski F. Swallowing-related quality of life in oral cavity cancer. The German version of the Anderson Dysphagia Inventory. HNO 2010; 58 (07) 692-697
• 25 Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia Handicap Index: Development and Validation. Dysphagia 2011; 20 Epub ahead of print