Zusammenfassung
Hintergrund: Infantile Zerebralparesen (IZP) sind häufig mit Schluckstörungen assoziiert. Mithilfe der fiberoptisch-endoskopischen Schluckdiagnostik sollten typische pathologische Befunde erfasst und quantifiziert sowie mit ausgewählten anamnestischen Aspekten in Bezug gesetzt werden.
Patienten und Methoden: 54 Patienten mit spastischer Tetraparese (Altersspanne: 3 Monate bis 15 Jahre und 11 Monate) wurden fiberoptisch-endoskopisch im Hinblick auf ihre Schluckfähigkeiten untersucht.
Ergebnisse: Über 60% der endoskopisch untersuchten Patienten wiesen Probleme mit der Bewältigung des Speichels auf und boten Speichelpenetrationen (24%) bzw. -aspirationen (39%). Bei Durchführung von Schluckversuchen hatten 2/3 der Patienten eine Nahrungspenetration oder -aspiration, über die Hälfte davon ohne Auslösung eines Hustenreflexes. Vormals oral ernährte Patienten zeigten in 40% Nahrungsaspirationen. Ebenfalls rund 40% betrugen jeweils die Häufigkeiten von Speichel- und Nahrungsaspirationen bei Kindern ohne Pneumonieanamnese. Vorbestehende drooling-Phänomene waren bei über der Hälfte der Untersuchten mit Speichelaspirationen (54%) oder Nahrungsaspirationen (53%) assoziiert.
Schlussfolgerungen: Die fiberoptisch-endoskopische Diagnostik beim spastisch-tetraparetischen Kind ermöglicht die Erkennung der potenziell bedrohlichen Penetration oder Aspiration von Speichel, Sekreten und Nahrung. Sie bietet dem Behandler somit die Möglichkeit, z. B. mittels Änderung des Nahrungs- und Atemwegsmanagements zu reagieren. Vermeintlich gefahrlos oral ernährte Kinder sowie Kinder ohne Pneumonie-Anamnese zeigten zu einem erheblichen Teil schwere Schluckdefizite. Auch Patienten mit drooling-Phänomen müssen als besonders aspirationsgefährdet angesehen werden.
Abstract
Dysphagia in Children with Cerebral Palsy – Fiberoptic-endoscopic Findings
Objective: Cerebral Palsy (CP) is associated frequently with swallowing disorders. By means of fiberoptic endoscopy, pathological findings in dysphagic patients with CP have been intended to be described, to be quantified, and to be related to selected anamnestic aspects.
Patients and Methods: Swallowing competency has been analysed endoscopically in 54 patients with spastic tetraparesis (range of age: 3 months to 15 years and 11 months).
Results: Over 60% of all patients examined endoscopically showed deficits in terms of penetration (24%) or aspiration (39%) of saliva. Two-thirds of the patients who have been tested with food had a penetration or aspiration of food, more than half of them without airway protection by cough reflex. Patients who have been fed orally before examination reported aspirations of food for 40%. Interestingly, about 40% of the children without history of pneumonia had aspirations of saliva and food. Drooling phenomena where associated with aspirations of saliva in 54% and with aspiration of food in 53% of our patients.
Conclusions: Fiberoptic endoscopy is useful to detect a potentially dangerous penetration or aspiration of saliva, secretions and food. Thereby it enables the physician to change airway and feeding management. This is of special importance as children who formerly have been fed orally without suspicion of risks and pneumonia anamnesis turned out to have severe swallowing deficits. A close connection between appearance of drooling phenomena and aspiration of saliva and food has also to be considered in children with CP.
Schlüsselwörter
infantile Zerebralparese - Dysphagie - fiberoptisch-endoskopische Befunde - kindliche Schluckstörung - spastische Tetraparese
Key words
cerebral palsy - dysphagia - fiberoptic endoscopy
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Korrespondenzadresse
Dr. Carl-Albert Bader
Universitätsklinikum des Saarlandes
Klinik für Hals-Nasen- und Ohrenheilkunde
Kirrberger Straße 1/Gebäude 6
66421 Homburg/Saar
eMail: Carl-Albert.Bader@uniklinikum-saarland.de
