Relação entre medidas quantitativas de língua e resíduos faríngeos na doença do neurônio motor

Abstract

Introduction: Progressive motor impairment caused by Motor Neuron Disease (MND) compromises the structures involved in swallowing, including the tongue. Disorders in the tongue may contribute to the presence of pharyngeal residues in these patients. Purpose: Relate tongue thickness, pressure and resistance to pharyngeal residues in the individual with NMD. Methods: This dissertation consists of two articles. The first is an integrative literature review that aimed to compare observation parameters and the execution procedures and analysis of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) protocols for individuals with MND. The second article is a cross-sectional study with a sample of 21 patients with NDM, mean 60.29 (± 13.21) years old, 13 (61.9%) men, all submitted to: 1) anamnesis and clinic evaluation of swallowing; 2) measurement of tongue pressure and resistance through the Iowa Oral Performance Instrument (IOPI); 3) FEES to verify the presence of residue in valleculae, according to the Yale Pharyngeal Residue Rating Scale Scoring System; 4) Tongue ultrasound to measure tongue thickness. To verify the difference of means of quantitative tongue measurements between groups with and without residue in valeculae, the nonparametric Mann Whitney test was applied, with a significance level of 5%. Results: In article one, after analyzing the seven selected articles, it was found that in the VED protocols for patients with MND there is heterogeneity in the execution and analysis procedures, but there is consensus regarding the observation of pharyngeal residues, laryngeal penetration and laryngotracheal aspiration. In article two, all quantitative tongue measures were below the expected values for normal subjects. Pressure (p = 0.51), resistance (p = 0.48) and tongue thickness (p = 0.94) were not related to the presence of residues in valleculae, although all means were lower in the group with residues. Conclusion: Article one concluded that in FEES protocols for patients with MND there is consensus only regarding the observation of pharyngeal residues, laryngeal penetration and laryngotracheal aspiration. In article two, no significant relation was found between quantitative measurements of tongue and vallecula residues in patients with MND.