Assessment And Clinical Value Of Pharyngeal Swallowing Function In PD Patients By VFSS

Objective:Observing the pharyngeal swallowing function of PD patients with the videofluroscopic study of swallowing(VFSS),and analyzing the influence of food texture on pharyngeal swallowing function in PD patients.Methods:Sixty-six inpatients with PD diagnosed in Department of Neurology of our hospital from March 2015 to May 2016 were collected.The drinking water test and VFSS were examined on the same day.1.Drinking water test: Before performing VFSS,Cough situation of the patients having 30 ml water one-time will be observed,Cough is positive that included in the aspiration group.Otherwise,those who did not have a cough will included in the non-aspiration group.2.VFSS:patients orally administered with 20 ml of liquid(iohexol),a thicker mixture(milk)and a thick material(yogurt)mixed with contrast agent.The contrast agent or food group are swallowed completely by patients as much as possible.And the machine could record and save its swallowing process.According to the presence or absence of pharyngeal dysphagia divided into dysphagic group and non-swallowing disorder group by the results of the VFSS.Then the dysphagia group was divided into aspiration group and non-aspiration group according to whether the contrast agent entered the airway.If severe aspiration occurs,the examination shall be terminated immediately.As a control group,66 cases with the same sex ratio,the same age(or a difference of1-2 years old)were collected from the 1763 subjects who undergoes gastrointestinal radiography examination in our radiology department in order to physical examination and diseases of the digestive system,that having not the disease which may be influence swallowing function.Obtaining their pharyngeal VFSS imaging data during the gastrointestinal angiography.The age,course of disease,and sex between the dysphagic group and the non-swallowing group,the aspiration group,and the non-aspiration group were compared using the Mann-Whitney U test,respectively.The comparison of the incidence of dysphagia between the control group and the PD group and the comparison of the detection rate of PD aspiration between the drinking water test and VFSS were performed using Chi-square test.Spearman correlation analysis was used to examine the relationship between pharyngeal dysphagia manifestation and aspiration,and analyse the effect of food texture on PD swallowing function.Analysis of risk factors for aspiration of PD using LOGISTIC regression.All data were analyzed by SPSS 19.0.The two-sided test was performed with ?=0.05,P<0.05,The difference was statistically significant.Results:1.The incidence of pharyngeal dysphagia in the control groups and PD groups was7.6%(5/66)and 65.1%(43/66),separately.There was a statistically significant difference between the groups(P<0.05).2.VFSS results of PD patients showed that there were 33 cases of residue in the epiphany valley,19 cases of residue in the pyriform sinus,23 cases of laryngeal motor dysfunction,2 cases of pharyngeal muscle abnormalities,4 cases of pharyngeal transit time prolonged,29 cases of repeated swallowing and 23 cases of aspiration.3.The detection rate of PD aspiration by VFSS and the drinking water test was100%(23/23)and 34.8%(8/23),respectively.The difference between groups was statistically significant(P<0.01).4.Spearman correlation analysis showed no significant difference that the relationship between residue in the epiphany valley,pharyngeal muscleabnormalities,pharyngeal transit time prolonged,repeated swallow and PD aspiration,separately(P>0.05).The Spearman correlation between residue in the pyriform sinus,laryngeal motor dysfunction and PD aspiration were both P<0.05,and the correlation coefficients were 0.378 and 0.733,respectively.At a level of confidence of0.05,there was a significant correlation.Logistic regression analysis between laryngeal motor dysfunction and aspiration showed statistical significance at 95% confidence interval,OR = 57.917.5.In aspect of age,gender,and duration of disease,there was no statistical difference between dysphagia group and non-swallowing disorder group(P>0.05).The aspiration group and the non-aspiration group(P>0.05),too.6.The results of Spearman correlation analysis between iohexol,milk and yogurt and PD pharyngeal dysphagia was all P<0.05,and the correlation coefficient was gradually increased,0.552,0.588,0.665,respectively.The results with PD aspiration was all P<0.05,the correlation coefficient gradually decreased,0.740,0.297,0.267,separately.Conclusion:1.Pharyngeal dysphagia exists in PD patients.2.There are multiple abnormal manifestations of dysphagia in the pharyngeal phase of PD patients,including residue in the epiphany valley and the pyriform sinus,laryngeal motor dysfunction,pharyngeal muscle abnormalities,pharyngeal transit time prolonged,repeated swallowing,and aspiration,of which residue in the the epiphany valley,laryngeal motor dysfunction,repeated swallowing,and aspiration were more common.3.Silent aspiration exists in PD patients.4.Residue in the pyriform sinus and laryngeal motor dysfunction were both significantly associated with the occurrence of aspiration in PD patients,and laryngeal motor dysfunction may be a risk factor for aspiration in PD patients.5.The age,gender,and duration of the disease were not associated with pharyngeal dysphagia and aspiration in PD patients.PD patients may happen pharyngeal dysphagia,or aspiration,even silent aspiration at any stage of the disease,any age,and regardless ofgender.6.Food texture had influence on swallowing function in PD patients.With the increase of food concentration,the risk of PD aspiration gradually decreased.However,the risk of PD pharyngeal dysphagia increased,mainly in residue in the epiphany,residue in the pyriform sinus,repeated swallowing.