Positionspapier der DGHNO und der DGPP – Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen

Zusammenfassung

Schluckstörungen sind häufig. Sie können zu erhöhter Mortalität durch aspirationsbedingte Lungenkomplikationen und Mangelernährung einerseits sowie einer erheblichen Beeinträchtigung der Lebensqualität andererseits führen. Die demografische Entwicklung in Deutschland lässt einen kontinuierlichen Anstieg der Dysphagie in den kommenden Jahren erwarten. Schwerpunkte sind dabei neurodegenerative Erkrankungen, die Tumoren im Verlauf der Schluckstraße und die Folgen der Tumorbehandlung im oberen Aerodigestivtrakt.

Vorrangig sind die Ärzte aus dem HNO-Bereich und der Phoniatrie als kompetente Fachgruppen zentrale Ansprechpartner für die Diagnostik und Therapieplanung der Dysphagie.

Die meist komplexen Störungen verlangen eine differenzierte Anamnese, Diagnostik und eine symptomorientierte Behandlung.

Das Einbeziehen auch von nicht-ärztlichen Fachgruppen wie Logopäden, Physiotherapeuten und Ergotherapeuten in die Planung einer effizienten Therapie erweitert und komplettiert die kompetente patientenzentrierte Betreuung. Die konservative Dysphagietherapie durch Logopäden und ähnliche Fachgruppen ist, auch längerfristig, ein wichtiges Standbein der Behandlung. Zudem können Anteile der spezifischen Diagnostik in enger Kooperation übernommen werden.

Eine interdisziplinäre Zusammenarbeit insbesondere mit den intensivmedizinischen neurologischen und internistischen Fachgruppen ist erforderlich.

Die in diesem Positionspapier beschriebenen Verfahren der speziellen Endoskopie gehören zu den originären ärztlichen Leistungen, vornehmlich der Fachärzte für Hals-, Nasen-, und Ohrenheilkunde bzw. für Sprach-, Stimm- und kindliche Hörstörungen (Phoniatrie und Pädaudiologie).

Die Endoskopie ist eine ärztliche Leistung, die grundsätzlich nicht delegierbar ist „In keinem Fall delegierbar sind Leistungen der Endoskopie (außer Kapselendoskopien, die durch speziell ausgebildete nichtärztliche Mitarbeiter geführt werden können) und der Sonografie“ siehe [278]. Entsprechend ist eine Substitution des Arztes ausgeschlossen.

Abstract

Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and Adults

Swallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.

Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.

A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.

In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.

The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.

Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.

Schlüsselwörter

Schlucken - Dysphagie/Ätiologie/Diagnostik - Aspiration - Oropharynx/Pathophysiologie - Laryngoskopie

Key words

swallowing - disorders/etiology/diagnostics - aspiration - oropharynx/pathophysiology - laryngoscopy

Publikationsverlauf

Artikel online veröffentlicht:
10. April 2015

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