Videoendoscopic Examination Findings in Elderly Patients with a History of Aspiration Pneumonia

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  • YOKOZEKI Ayaka
    Department of Rehabilitation, Kurashiki Kinen Hospital
  • MORITA Norimasa
    Department of Rehabilitation, Kurashiki Kinen Hospital Department of Otolaryngology, Kurashiki Kinen Hospital
  • OBAMA Naoya
    Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare
  • NAGAMI Shinsuke
    Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare
  • HUKUNAGA Shinya
    Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare

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  • 誤嚥性肺炎の既往を伴う高齢者の嚥下内視鏡検査所見について
  • ゴエンセイ ハイエン ノ キオウ オ トモナウ コウレイシャ ノ エンカ ナイシキョウ ケンサ ショケン ニ ツイテ

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Abstract

<p>　Background and Purpose:　The presence of dysphagia is closely related to aspiration pneumonia and has been shown to increase the risk of developing aspiration pneumonia. In our hospital, we mainly perform videoendoscopic (VE) examination for observing swallowing dynamics of patients who are suspected of dysphagia. VE examination is a simple and useful method for diagnosing dysphagia. However, there are few reports that have examined factors associated with the onset of aspiration pneumonia based on VE findings, and sufficient research has not been performed. The purpose of this study was to elucidate the factors associated with aspiration pneumonia by analyzing swallowing dynamics obtained from VE findings, focusing on older patients because cases of aspiration pneumonia are frequently encountered among the elderly in clinical sites.</p><p>　Methods:　The present study included 254 elderly patients aged 65 years or older, who underwent VE for suspected dysphagia. Of these, 54 and 200 patients had a history of aspiration pneumonia and no history of aspiration pneumonia, respectively. The VE findings were compared between the two groups. In addition, statistical comparison tests were performed for posture during examination, Fujishima dysphagia scale (FILS), and nutritional status.</p><p>　Results:　A comparison between the groups with and without previous aspiration pneumonia showed significant differences in male, older age, presence of neurological disease, posture during examination, and FILS (p＜0.05). The VE findings showed significant differences in the degree of glottis closure, salivary retention in the pyriform sinus, premature spillage into the pharynx and post-swallow pyriform sinus pooling of liquid (p＜0.05). In a logistic regression analysis using the presence or absence of a history of aspiration pneumonia as the objective variable and the VE items that showed significant differences between the two groups as explanatory variables, early pharyngeal inflow was extracted.</p><p>　Conclusions:　Premature spillage into the pharynx on VE was shown to be a highly relevant factor in patients with a history of aspiration pneumonia.</p>

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