Author(s)
Yoshihiko - Kumai
Affiliation(s)
Department of Otolaryngology Head and Neck Surgery Kumamoto University Graduate school of Medicine
Abstract:
Objective: To examine oropharyngeal swallowing dysfunction in myasthenia gravis (MG)patients presenting difficulty in swallowing by videofluorographic (VF) and fiberoptic endoscopic (FE) evaluation. Method: Swallowing studies of ten MG patients with difficulty in swallowing at various time points over the exacerbation and remission stages of disease were reviewed (mean age, 54.3 y). These patients were consulted from department of neurology in our institution during June/2016~July/2017. The assessment parameters on VF and FE examination are set as follows: swallowing initiation, bolus stasis at pyriform sinus (PS) and vallecula (VC) and degree of aspiration using four point scale. Associations between these parameters, and clinical neurological evaluation such as MGFA clinical classification (MGFA II a; 1, III a; 4, II b; 4, III b; 1), MG-ADL score and QMG score were statistically determined.Results: No patients demonstrated aspiration. However, patients classified as MGFA IIb or IIIb presented significant (p<0.05) sever degree of pharyngeal residue at both PS and VC in comparison with patients classified as MGFA IIa or IIIa possibly due to lowered pharyngeal constriction. MG-ADL and QMG scores are significantly (p<0.05) correlated with total scores of four evaluated parameters. (r=0.57, 0.51, respectively) Conclusion:Even presenting no aspiration, patients classified as MGFA IIb or IIIb or scored as high MG-ADL and QMG scores, needs to be taken care of swallowing dysfunction in terms of lowered pharyngeal clearance. Control of such pharyngeal residue, especially in patients classified as MGFA IIb or IIIb is the key for prevention of aspiration.