Yutma bozukluğu olan hastalarda rehabilitasyon yöntemleri ve sonuçları

Amaç: Yutma bozuklukları kulak burun boğaz pratiğinde sık karşılaşılan bir durumdur ve disfaji, tanı vetedavisinde güçlüklerle karşılaşılan bir semptomdur.Bu çalışmada yutma bozukluğu olan hastalar değerlendirmeye alındı. Hastalar ve Yöntemler: Kliniğimize Ekim 2000-Haziran 2002 tarihleri arasında yutma sorunları nedeniyleyutma polikliniğine başvuran 280 hasta 153 erkek, 127kadın; ort. yaş 53; dağılım 3-98 yaş incelendi. Hastaların ayrıntılı öyküsü alındı; yutma değerlendirme anketformu ile yakınmaları değerlendirildi; kliniğimizin tanıprotokolüne göre servikal oskültasyon, modifiye baryumlu yutma çalışmaları uygulandı; gerektiğinde fiberoptik endoskopik yutma, dil kökü ultrasonografisi, boyun tomografisi veya reflü açısından çift problu özofajeal pH metre çalışması da tanıya yardımcı yöntemlerolarak eklendi.Bulgular: Değerlendirme sonrasında 164 hasta yutmabozukluğu tanısı ile göllenme, prematür kaçak, penetrasyon/aspirasyon ve gecikmeli yutma yutma rehabilitasyonu programına alındı. Disfajinin hastaların%55’inde mekanik kökenli, %32’sinde nörolojik kökenliolduğu belirlendi. Rehabilitasyon çok aşamalı olarakpozisyonlama, kıvam ayarlama, oral-motor açıklık vekuvvetlendirme egzersizleri, yutma apereleri ve yutmateknikleri olarak uygulandı. Tedavi sonrasında 128hasta %78 normal yemek yemeye başladı.Sonuç: Yutma bozukluğu olan hastalarda mekaniknedenlerin de incelenmesi gerektiği kanısına varıldı

Anahtar Kelimeler:

Yutma sorunları/etyoloji/tanı/tedavi, endoskopi, sindirim sistemi, floroskopi, manometri, orofarenks, peristaltizm.

The management of swallowing disorders through rehabilitation methods

Objectives: Swallowing disorders are commonly encountered in ENT practice, and dysphagia may pre- sent a challenge with respect to diagnosis and man agement. This study aimed to examine patients with swallowing disorders.Patients and Methods: The study included 280 patients 153 males, 127 females; mean age 53 years; range 3- 98 years who presented with complaints of swallowing difficulties betvveen October 2000 and June 2002. The patients were examined according to the protocol of our department for swallowing disorders, which involved a detailed history taking, a patient questionnaire on swal- lovving disorders, cervical auscultation, and modified bar- ium swallow studies. When further investigation was needed, fiber-optic endoscopic swallow studies, ultra- sonic evaluation of the tongue base, neck CT, and 24- hour double-probe pH monitoring were also undertaken.Results: A diagnosis of a swallowing disorder prema türe spills, pulling in the vallecula and/or pyriform sinuses, penetration and/or aspiration, and delayed swallow reflex was made in 164 patients. Dysphagia arose from a mechanical cause in 55%, and from a neurological cause in 32%. A multiphase rehabilitation program was initiated, which included positioning, adjusting bolus con- sistency, oral-motor range of motion exercises, use of palatal devices and swallowing techniques. Rehabilitation resulted in normal swallowing in 128 patients 78% .Conclusion: Mechanical causes should also be sought in patients with swallowing disorders.

Keywords:

Deglutition disorders/etiology/diagnosis/therapy, endoscopy, digestive system, fluoroscopy, manometry, oropharynx, peristalsis,

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