Abstract
Objective
To examine the correlation between the results of a clinical neurological evaluation
and swallowing dysfunction in myasthenia gravis (MG) patients who presented with difficulty
in swallowing and underwent videofluorographic (VF) and fiber-optic endoscopic (FE)
evaluation.
Methods
The swallowing studies of 13MG patients with difficulty in swallowing seen at the
Department of Neurology from June 2016 to April 2018 were reviewed. The assessment
parameters on VF and FE examination were as follows: swallowing initiation, bolus
stasis at the pyriform sinus (PS) and vallecula (VC), and the degree of aspiration.
They were assessed using a 4 or 5-point scale. Associations between these parameters
and the clinical neurological evaluation, which included the Myasthenia Gravis Foundation
of America (MGFA) clinical classification, the MG Activities of Daily Living score,
and a quantitative MG score, were statistically determined.
Results
No patients demonstrated aspiration. However, in patients MGFA IIb/IIIb disease, the
Hydo’s FEES scale and pharyngeal residue examined using VF were significantly (p < 0.05) more severe than in patients classified with MGFA IIa/IIIa disease. None of
the parameters evaluated with VF and FE correlated significantly with the clinical
neurological evaluation except for the grip assessment.
Conclusion
While not presenting with aspiration but with swallowing difficulty alone, patients
classified with MGFA IIb/IIIb disease, regardless of clinical neurological evaluation,
require care addressing the reduced pharyngeal clearance. Controlling the severity
of the pharyngeal residue may be the key to preventing silent aspiration, especially
in patients with MGFA IIb/IIIb disease.
Keywords
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Article Info
Publication History
Published online: November 01, 2018
Accepted:
October 17,
2018
Received in revised form:
September 23,
2018
Received:
July 3,
2018
Footnotes
☆This paper was presented as a poster at the annual meeting of the American Broncho-Esophagial Association (ABEA) at Combined Otolaryngology Spring Meeting (COSM) which was held in Washington D.C. Maryland on April 19th 2018.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
