Tek Taraflı Ses Teli Paralizisi Olan Hastalarda Aspirasyon- Penetrasyon Varlığının Değerlendirilmesi

Year 2020, Volume: 3 Issue: 1, 91 - 108, 09.05.2020

Serkan Bengisu , İlayda Gündüz

Abstract

Amaç: Tek taraflı ses teli paralizisi (STP) olan hastalarda aspirasyon-penetrasyon varlığının değerlendirilmesi ve subjektif değerlendirme yöntemi olan Gugging Yutma Tarama Testi (Gugging Swallowing Screen-GUSS) ile objektif değerlendirme yöntemi olan Fiberoptik Endoskopik Yutma Çalışması (FEYÇ)’in sonuçları arasındaki korelasyonun hesaplanmasıdır. Yöntem: Bu çalışmada ilişkisel araştırma modeli kullanılmıştır. Bu çalışma İstanbul Samatya Eğitim Araştırma Hastanesi Kulak Burun Boğaz kliniğine başvuran, tek taraflı STP tanısı olan 8 hasta ile gerçekleştirilmiştir. Hastalara dil ve konuşma terapisti tarafından GUSS ve Kulak Burun Boğaz hekimi tarafından FEYÇ uygulanmıştır. Bulgular: GUSS değerlendirmesine göre 8 hastanın %75’inde ve FEYÇ değerlendirmesine göre %50’sinde aspirasyon-penetrasyon bulgularına rastlanmıştır. FEYÇ skorları ile GUSS skorları arasında istatistiksel olarak anlamlı ilişki bulunmamıştır (r=-0.247; p=0.555). Her ne kadar anlamlı bir ilişki elde edilemese de GUSS ile aspirasyon-penetrasyon olduğu düşünülen 6 hastanın 4’ünde objektif değerlendirme sonrasında da aspirasyon-penetrasyon varlığına rastlanmış olması dikkat çekicidir. Sonuç: İstatistiksel olarak FEYÇ ile GUSS skorları arasında anlamlı ilişki bulunmamasının nedeninin çalışmaya dahil edilen katılımcıların sayısının yetersiz olmasından kaynaklandığı düşünülmektedir. Tek taraflı STP olan hastalarda vokal kordların paraliziye bağlı olarak hareketsiz kalması sonucu hava yolu korunumunda aksaklıklar meydana gelebilmektedir. Bu çalışma kapsamında yapılan GUSS ve FEYÇ değerlendirmelerine göre, STP olan hastaların büyük bir çoğunluğu aspirasyon ve/veya penetrasyon belirtileri göstermektedir. GUSS, aspirasyon varlığını değerlendirmede objektif bir değerlendirme yapılamadığı durumlarda alternatif bir ölçme aracı olarak klinik ortamda kullanılabilir ve tek taraflı STP olan hastalarda aspirasyon varlığı hakkında fikir verebilir; fakat bu hastaların FEYÇ gibi objektif değerlendirme araçlarıyla ileri değerlendirme almaları gereklidir.

Keywords

disfaji, yutma bozukluğu, vokal kord paralizi, aspirasyon, penetrasyon

Evaluation of the Presence of Aspiration-Penetration in Patients with Unilateral Vocal Cord Paralysis

Abstract

Purpose: The purpose of this study was to evaluate the presence of aspiration-penetration in patients with unilateral vocal cord paralysis, and to examine the correlation between the findings of the Gugging Swallowing Screen (GUSS), which is a subjective evaluation method, and the Fiberoptic Endoscopic Swallowing Study (FEES), which is objective. Method: Correlational research model was used in this study. 8 patients with unilateral vocal cord paralysis who were seen at the ear nose throat clinic of İstanbul Samatya Education Research Hospital within a 6-month period in 2018 and the beginning of 2019 were included in this study. 4 of the 8 patients (50%) were female and 4 (50%) were male. In 4 patients (%50), the paralysis was seen in the right vocal cord and in the other 4 patients (%50), in the left vocal cord. The cause of paralysis in 4 of 8 patients (%50) was thyroidectomy, in 3 (%37,5), it was idiopathic and in 1 (%12,5) patient, it was seen following pneumonectomy. After filling out an information form with the medical history and complaints of the patients, GUSS was administered by a speech and language therapist and FEES was implemented by an ear nose throat doctor. Results: 6 (75%) of the 8 patients were diagnosed with the presence of aspiration-penetration using GUSS, and 4 (%50) were diagnosed to have aspiration-penetration using FEES. There was no relationship between the FEES and the GUSS scores (r=-0.247; p=0.555). Conclusion: In patients with unilateral VCP, as a result of the vocal cords being immobilized due to paralysis, airway protection may deteriorate. The GUSS and FEES assessments performed in this study showed that a large majority of patients with VCP demonstrated signs of aspiration and/or penetration. Assessment with GUSS resulted in identifying more cases as having aspiration- penetration than FEES. 4 of 6 patients who were diagnosed to have aspiration-penetration with the GUSS evaluation were also found to have aspiration-penetration following objective evaluation, FEES. The other two were possibly false positives. False positives are likely to urge patients and therapists to be more cautious in therapy. Therefore, it can be concluded that GUSS can be used as an alternative measurement tool in clinical conditions and can give an idea of aspiration presence in patients with unilateral VCP, in cases where an objective assessment of aspiration is not possible. These results are in line with the literature findings. For further confirmation, it is recommended that the study be repeated with a larger number of patients.

Keywords

dysphagia, swallowing disorder, vocal cord paralysis, aspiration, penetration

References

• ASHA. Swallowing Disorders in Adults, American Speech-Language-Hearing Association. https://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/
• AKÇİL, M. (2015). Pnömoni Öyküsü Olan Yaşlılarda Yutma Fonksiyonunun Değerlendirilmesi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü Fizik Tedavi ve Rehabilitasyon Programı Yüksek Lisans Tezi, Ankara, 2015.
• AVIV, J. E., KIM, T., THOMSON, J. E., SUNSHINE, S., KAPLAN, S., & CLOSE, L. G. (1998). Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) in Healthy Controls. Dysphagia, 13(2), 87–92.
• BHATTACHARYYA, N., Kotz, T., & Shapiro, J. (2002). Dysphagia and Aspiration with Unilateral Vocal Cord Immobility: Incidence, Characterization, and Response to Surgical Treatment. Annals of Otology, Rhinology & Laryngology, 111(8), 672–679.
• BOESCH R., DEBOER M. (2019). Aspiration. Kendig's Disorders of the Respiratory Tract in Children (9), 1097-1105.
• BRADY, S., & DONZELLİ, J. (2013). The Modified Barium Swallow and the Functional Endoscopic Evaluation of Swallowing. Otolaryngologic Clinics of North America, 46(6), 1009–1022.CARRUTHERS D.G. (2013). Paralysis Of The Vocal Cords. Diseases of the Ear, Nose, and Throat, (2), 295-302.
• COUNTER, P. R., & ONG, J. H. (2018). Disorders of swallowing. Surgery (Oxford).
• JACKSON, S., & EASTAUGH-WARİNG, T. (2018). Regurgitation and aspiration. Anaesthesia & Intensive Care Medicine, 19(9), 471–474.
• JAFARİ, S., PRİNCE, R. A., KİM, D. Y., & PAYDARFAR, D. (2003). Sensory Regulation of Swallowing and Airway Protection: A Role for the Internal Superior Laryngeal Nerve in Humans. The Journal of Physiology, 550(1), 287–304.
• JANG, Y. Y., LEE, S. J., JEON, J. Y., & LEE, S. J. (2011). Analysis of Video Fluoroscopic Swallowing Study in Patients with Vocal Cord Paralysis. Dysphagia, 27(2), 185–190.
• KARADUMAN A, SEREL S, ÜNLÜER Ö, DEMİR N. (2012). Penetrasyon Aspirasyon Skalası: kişiler arası güvenirlik çalışması. Fizyoter Rehabil. 2012;23(3):151-155.
• MORLEY, J. E. (2015). Dysphagia and Aspiration. Journal of the American Medical Directors Association, 16(8), 631–634.
• PATEL, N., REED, A., DAR, O., & SİMON, A. (2018). Vocal Cord Paralysis and Aspiration Post Ventricular Assist Device Implantation. The Journal of Heart and Lung Transplantation, 37(4), S295.
• RAOL, N., SCHREPFER, T., & Hartnick, C. (2018). Aspiration and Dysphagia in the Neonatal Patient. Clinics in Perinatology.
• SHAKER, R., REN, J., KERN, M., DODDS, W. J., HOGAN, W. J., & Lİ, Q. (1992). Mechanisms of Airway Protection and Upper Esophageal Sphincter Opening During Belching. American Journal of Physiology-Gastrointestinal and Liver Physiology, 262(4), G621–G628.
• TABAEE, A., MURRY, T., ZSCHOMMLER, A., & DESLOGE, R. B. (2005). Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in Patients With Unilateral Vocal Fold Immobility: Incidence and Pathophysiology of Aspiration. The Laryngoscope, 115(4), 565–569.
• VESEY, S. (2013). Dysphagia and quality of life. British Journal of Community Nursing, 18(5), 14-19.
• WALTON, J., & SİLVA, P. (2018). Physiology of swallowing. Surgery (Oxford).
• WARNECKE, T., IM, S., KAISER, C., HAMACHER, C., OELENBERG, S., & DZIEWAS, R. (2017). Aspiration and dysphagia screening in acute stroke - the Gugging Swallowing Screen revisited. European Journal of Neurology, 24(4), 594–601.