Ursachen, Diagnostik und Therapie neurogener Dysphagien

ZUSAMMENFASSUNG

Die neurogene Dysphagie ist eines der häufigsten und lebensbedrohlichsten Symptome neurologischer Störungen wie Hirninfarkte oder neurodegenerative Erkrankungen. Da die durchschnittliche Lebenserwartung stetig steigt, ergibt sich prognostisch ebenfalls ein Anstieg an darunter leidenden Patienten. Entsprechend befasst sich die vorliegende Arbeit mit der Erläuterung und Bewertung der im klinischen Alltag durchgeführten Maßnahmen in Bezug auf Prognose, Diagnostik und Therapie bei neurogener Dysphagie. Es wurde in 2 Literaturdatenbanken (PUBMED; EMBASE) systematisch nach Studien zu Ursachen, Diagnostik und Behandlung von neurogenen Dysphagien gesucht und eine gezielte Auswahl von Studien getroffen, die sich mit Dysphagien in Folge neurologischer Erkrankungen befassten. Einzelfallberichte wurden ausgelassen, klinische Studien jeder sonstigen Art miteingeschlossen. Das Review fasst die Ergebnisse von 24 Studien zusammen. Es zeigte sich, dass mittels flexibler endoskopischer Bewertung des Schluckens (FEES), standardisierter Schluckuntersuchung (SSA), Anamnese und Bildgebung bereits früh eine Prognose zum Ausmaß der Dysphagie möglich war. Zudem zeigte sich die SSA als sinnvolle Maßnahme zur Detektion von Aspirationen, durch eine FEES konnten vermehrt stille Aspirationen erkannt werden und die videofluoroskopische Schluckuntersuchung (VFSS) hatte Vorteile in der Bewertung des Ablaufs der Schluckphasen. Therapeutisch erwiesen sich, je nach Ergebnissen der vorangegangenen Untersuchungen, Schlucktherapie und das Andicken von Flüssigkeiten als effizient, bei bestimmten Krankheitsbildern (Z. n. Hirninfarkt bei gleichzeitig bestehendem Z. n. Dekanülierung) ergab sich bei pharyngealer Elektrostimulation ein positives Bild.

ABSTRACT

Neurogenic dysphagia is one of the most common and dangerous symptoms of neurologic diseases such as strokes or neurodegenerative illnesses. As the average age of the general population increases, the number of cases will likely grow as many these diseases associated with neurogenic dysphagia are more common in the elderly. The effects of dysphagia are severe and have a significant impact on case outcome and mortality, especially when considering that the most common complications are aspiration pneumonia, malnutrition, and dehydration. It is crucial for doctors to know how to treat it. The goal of this review is to explain and evaluate the current options in prognosis, diagnosis, and treatment of neurogenic dysphagia. It consolidates information found in 24 high quality studies collected from two platforms (pubmed, embase). Through FESS, standard swallowing assessment (SSA), anamnesis and MRI, doctors can give an early prognosis on how the dysphagia will develop. The studies reviewed showed that detecting aspirations via SSA was effective. Additionally, FEES could be used to detect more silent aspirations and VFSS could be used to evaluate all phases of swallowing. The studies also showed that correctly identifying silent aspirations and reacting to it adequately reduces the mortality. Furthermore, carbonated liquids and position changes were effective therapeutic options in some patients. Lastly, pharyngeal electric stimulation proved to be effective in most studies and pharmacological therapy was found to be effective in one study. All in all, one can conclude that diagnosis, logopedic treatment and nutrition changes are well explored. This probably leads to a significant decline of the mortality rate. Regarding future diagnostics, pharyngeal electrical stimulation and pharmacological therapy will likely be the important areas of future science.

Schlüsselwörter

Neurogene Dysphagie - Dysphagie - Schluckuntersuchung - endoskopische Schluckuntersuchung

Key words

Neurogenic Dysphagia - dysphagia - swallowing Assessment - endoscopic swallowing

Publikationsverlauf

Artikel online veröffentlicht:
02. November 2021

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