Feb. 2001
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1 Vol.47 No.2 Evaluation of accuracy of cervical auscultation for clinical assessment of dysphagia Kaoru HIRANO EKoji TAKAHASHI ERisa UYAMA Ken-ichi MICHI Abstract: Cervical auscultation (CA) is frequently used to clinically assess dysphagia. CA can distinguish respiratory and swallowing sounds in dysphagic patients from those in normal subjects. This study was done to evaluate the accuracy of CA. Thirty-seven patients with head and neck cancer were studied. Respiratory and swallowing sounds were detected by two accelerometers and recorded on VHS tape with videofluorographic (VF) images. Forty-four sound samples were edited and presented to six examiners through headphones. Each sound sample included expiratory sounds before swallowing, sounds produced by swallowing 5 ml barium, and expiratory sounds immediately after swallowing. Without referring to VF images, each examiner evaluated and classified the sound samples into one of five categories: normal (N), acceptable (Ac), residue (R), penetration (P), and aspiration (A). To evaluate the accuracy of CA, we assessed the rate of agreement between auditory evaluation and VF images. The following results were obtained: 1. The average accuracy was 55.3%, but the agreement rate of auditory evaluation with VF images within an error of one category averaged 79.5%. 2. When N and Ac were regarded to have no dysphagia, and R, P, and A were regarded to have dysphagia, the agreement rate between auditory evaluation and VF images averaged 83.5% in the two groups. 3. The agreement rate of A with coughing averaged 89.6%, and the agreement rate of A without coughing averaged 34.8%. However, the agreement rate of auditory evaluation of A without coughing with VF images averaged 76.5% for dysphagia. These results show the effectiveness of CA as a clinical tool for diagnosing dysphagia. First Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University (Chief: Prof. Ken-ichi Michi)
2 Feb. 2001
3 Vol.47 嚥下障害判定のための頸部聴診法の診断精度の検討 No.2 b a c 貯留 喉 頭侵 入 (Residue) 誤 嚥 (Penetration) 写 真1VF画 (Aspiration) 像 の例 表2VF画 *嚥 下 中 95 像 の判定,嚥 下 後 を 通 して,わ ず か な咳 払 い や 呼 吸 の つ か え が あ る場 合 も む せ あ り と判 定 し た 呼 気 音 か ら な る サ ン プ ル を 作 製 し,乱 数 表 に 従 っ た 順 序 で Aspiration)が 編 集 し て 判 定 実 験 用 の サ ン プ ル と した. め, むせ(咳 鰍 反射) の有 無 に よ り さ ら に2群 に 細 分 類 2-2)VF画 像の判定 した.こ の 際,判 定 はVF画 嚥 下 時 産 生 音 と 同 時 に 記 録 したVF画 ル 作 製 者 が 行 っ た(表2,写 聴 覚 的 に 識 別 可 能 で あ る か を検 討 す る た 真1),判 生 す る こ と に よっ て行 い,嚥 下 中,嚥 下 後 を通 して わず か 像 の判 定 はサ ン プ 定 は5段 階 で,嚥 像 と嚥 下 時 産 生 音 を 同 時 に 再 下 な咳 払 い や 呼 吸 の つか えが あ る場 合 も むせ あ り と判 定 後 に 造影 剤 が 喉 頭 蓋 谷 や 梨 状 陥 凹 に残 留 す る場 合 を貯 留 した.さ ら に誤 嚥,喉 頭 侵 入 あ る い は 貯 留 の 所 見 は 認 め ら (Residue:R),造 れ な いが 健常 嚥下 とはい え ない場 合(た とえば 食塊 の 送 り 影 剤 が 喉 頭 に 流入 す る が声 帯 下 まで 達 し な い 場 合 を 喉 頭 侵 入(Penetration:P)と し た.ま た,造 込 み が 障 害 され て い る場 合 な ど)を 許 容 嚥 下(Acceptable :AC)と 影 剤 が 声 帯 下 ま で 流 入 す る 場 合 を 誤 嚥(Aspiration:A) と し た が,誤 嚥 に 関 し て は,い わ ゆ る 不 顕 性 誤 嚥(Silent し,以 上 に述 べ た 異常 所 見 が 認 め られ ない 場合 を 健 常 嚥 下(Normal:N)と 31 した.
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8 2) Takahashi, K., Groher, M. E., et al.: Methodology for detecting swallowing sounds. Dysphagia 9: ) Zenner, P. M., Losinski, D. S., et al.: Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia 10: ) Darley, F. L., Aronson, A. E., et al.: Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 12: ) Kikuchi, R., Watanabe, N., et al.: High incidence of silent aspiration in elderly patients with community. Am Respir Crit Care Med 150:
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