VIDEOFLUOROGRAPHIC EVALUATION OF DYSPHAGIA IN PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY
Yoshiko Higuchi, K. Hanayama, T. Otsuka (National Higashisaitama Hospital, Saitama, Japan), M. Liu, N. Chino (Keio University, Japan)
Objective: Although there have been several reports on swallowing abnormalities in Duchenne muscular dystrophy (DMD) patients, no detailed data are available yet. The objective of this study is to evaluate their swallowing with videofluorography (VF) and correlate the severity of dysphagia with other clinical factors.
Methods: We performed VF studies in nineteen DMD patients (mean age 19.2 years; range 9-26), and correlated the severity of abnormalities with age, neck range of motion (ROM), neck muscle strength and subjective complaints of dysphagia.
Results: VF abnormalities were observed in 18 of the 19 patients. The abnormal findings included delayed elevation of larynx, pooling in the valleculae and pyriform sinus, vigorous neck extension to move the bolus posteriorly, and regurgitation from pharynx to oral cavity. For solid food, the severity of pooling in the pyriform sinus showed significant correlations with age and neck ROM (Spearman's rho corrected for ties=0.774 and -0.529, p<0.05). VF findings did not correlate with subjective complaints of dysphagia.
Conclusion: Although subjective complaints of dysphagia are rare in DMD patients, swallowing abnormalities are common on VF study.
AIRPUFF PUMP TO MEASURE SENSORY THRESHOLD OF ORAL CAVITY AND PHARYNX
Eiji Suzuki, Tohru Kondo, Mituru Majima, Kiyoshi Eguchi, Hiroshi Fujii, Gouhei Komiyama (Saitama Medical School, Saitama, Japan)
Abstract: Aviv measured sensory threshold at piriform sinus of normal adults by using airpuff pump (1993). We made the airpuff pump to see the relation between sensory threshold of oral cavity, pharynx and dysphagia caused by damage of central nervous system.
Compressed air was transferred through regulator and through pressure control valve to two serial air chambers (500ml each). Pressure was monitored at the latter chamber and electromagnetic valve (opening duration was 100msec) was connected. Airpuff spurted out from vinyl tube (2mm) to measure threshold. The vinyl tube was inserted with laryngo-fiber scope to check the accurate point of oral cavity and pharynx. The airpuff lasted about 70msec at the end of the tube. The pressure measured at the latter air chamber and the pressure measured at 2mm from the end of the tube showed simple linear regression. The pressure measured at 1mm from the end of the tube did not differ so much from that measured at 3mm from the end of the tube. We could spurt the airpuff at about 2mm from the mucosa of oral cavity and pharynx within the error of 1mm.
We measured sensory threshold at uvula, anterior area of palato-glossal arch, posterior wall of pharynx, superior part of epiglottis. We used up-and-down method to decide the threshold. Sensory thresholds of normal adults were 0.22mmHg at uvula, 1.1mmHg at anterior area of palato-glossal arch, 1.54mmHg at posterior wall of pharynx, 1.68mmHg at superior part of epiglottis. Sensory threshold of dysphagia patients varied so much. The relation between dysphagia type and sensory threshold is not clear until now.