28 Diagnosis and Differential Diagnosis of Dysphagia
摘要
Frequently used tests for dysphagia screening and clinical swallowing evaluation are presented. The functional swallowing examination with flexible endoscopes is introduced, addressing the FEES protocol, innovations and technical advances. The technical background of fibre-optic endoscopic evaluation of swallowing (FEES) and digital workstation recording of FEES surveys is elucidated and technological items are explained. After displaying an assessment protocol, FEES scoring systems are presented. Indications, technical considerations, radiation dose, examination technique, interpretation and combined investigations of radiological diagnostic tools are introduced. Catheter-based technology and capsule-based pH-metry are presented as options of pharyngeal and oesophageal pH-metry, the evaluation of pH-measurements is explained. Concerning manometry, multichannel intraluminal impedance devices and high-resolution manometry (HRM) are introduced. To explain sonography of the tongue during swallowing and infant sucking, examination methods are displayed and examples of normal tongue motions are presented during these acts. Possible diagnostic applications of ultrasound of tongue movements are discussed and an overview is given about digital developments and advances. Health-related quality of life (HRQoL) questionnaires for swallowing disorders are introduced addressing generic QoL instruments, dysphagia-specific QoL questionnaires, paediatric dysphagia-related HRQoL measures, HRQoL in the elderly with dysphagia and questionnaires for primary diseases that often result in oropharyngeal dysphagia. Options to detect and to diagnose swallowing events by automatic digital recording are explained, and mobile devices are presented.