Cricopharyngeal muscle dysfunction in the elderly

Introduction to pharyngeal muscle dysfunction in the elderly The elderly have high pressure, low pressure and relaxation abnormalities of the upper esophageal sphincter (UES) for different reasons, causing difficulty in swallowing of the oropharynx, called cyclopharyngeal muscle dysfunction. basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of infection: non-infectious Complications: aspiration pneumonia bronchitis bronchiectasis

Causes of circulatory dysfunction in the elderly

(1) Causes of the disease

The pharyngeal dyskinesia is associated with neurological diseases of the pharynx, neuromuscular diseases, local inflammation or tumors, such as bilateral recurrent laryngeal nerve palsy after thyroidectomy, poliomyelitis, cerebrovascular disease, hepatolenticular degeneration, Muscular dystrophy, thyroid tumors, etc.

(two) pathogenesis

During non-meal, the pharyngeal muscle maintains the closing function of the proximal esophagus, forming a barrier to prevent the reflux from entering the pharynx, and it also prevents gas from entering the esophagus (because the pressure in the esophagus is lower than the pharynx when inhaling), the ring The resting pressure of the pharynx is not the same, ranging from 5.33 to 13.30 kPa (40 to 100 mmHg), and 13.3 to 17.3 kPa (100 to 130 mmHg), and the upper end is high, the lower end is low, and the front and rear directions are high. The laterally low asymmetry may be related to the pressure of the laryngeal cartilage. When the food group reaches the pharynx, the pharyngeal part is displaced 2 to 3 cm in the direction of the mouth. The reflex relaxation of the UES and the pressure drop significantly. , almost 0 kPa, diastolic usually lasts 0.5 to 1.0 s, accepts the feeding group into the esophagus, and then the part contracts (the internal pressure can reach 2 times of the resting pressure), and spreads downward in the direction of peristalsis. Coordination status, high tension of UES due to various reasons (), low tension (relaxation), incomplete relaxation of UES (circumphantial achalasia), premature closure of UES (Zenker diverticulum) and relaxation of UES (familial Autonomous dysfunction), leading to abnormal function of the pharynx, can cause food Difficult to enter the esophagus from the pharynx, also known as oropharyngeal dysphagia, histopathological examination of primary cycloparyngeal muscle dysfunction can be found in increased fibrous tissue, because fibrosis often limits the esophageal sphincter during relaxation of the lumen The degree of openness, therefore, the fibrotic progression of the pharyngeal muscle in many patients is consistent with its clinical features.

Prevention of circulatory dysfunction in the elderly

Primary prevention: early control of hypertension, arteriosclerosis, complications of diabetes and cerebrovascular accidents, and attention to the treatment of primary disease,

Secondary prevention: symptoms appear, and the cause is determined by examination to improve the quality of life.

Complications of cyclopsynthesis in the elderly Complications aspiration pneumonia bronchitis bronchiectasis

Can be complicated by aspiration pneumonia, bronchitis or bronchiectasis, repeated lung infections.

Symptoms of pharyngeal muscle dysfunction in the elderly Common symptoms Dysphagia, cough, hoarseness

1. Special forms of difficulty in swallowing

The oropharyngeal difficulty of the oropharynx often occurs within 1 s of swallowing, causing the patient to feel unable to initiate swallowing, or the herd sticks or stops in the neck (possibly accompanied by pain) and cannot enter the esophagus, so that repeated attempts to swallow or If the liquid is swallowed, it will pass through the nasopharynx and then flow into the trachea (causing cough) or the nasal cavity. In severe cases, the saliva will not swallow and drool.

2. Coughing at mealtime

Immediately cough and swallow, enter the trachea through food or liquid through an incomplete barrier. Lung inhalation can cause repeated pneumonia, bronchitis or bronchiectasis. When you swallow, there is a "giggle" to indicate the presence of Zenker's diverticulum. In the case of recurrent nerves, nasal and dysphonia occur when the soft palate or the pharyngeal muscles are weak. In adults, any recurrent unexplained lung infection should be examined for esophageal function to determine if it is a lung inhaled substance. source.

3. Weight loss

Patients avoid eating due to difficulty swallowing (fear of food), or fear of swallowing pain and inhalation and eating less, resulting in weight loss, unexplained weight loss can be used as a clue to swallowing disease.

Examination of circumcis dysfunction in the elderly

White blood cells can be normal or elevated.

X-ray film photography

The mouth, the pharynx and the upper esophagus can be continuously observed during the swallowing, and the complex and rapid continuous process can be recorded. The dynamic recording of the swallowing should include side view and front view, and can be swallowed with tinctures of different consistency.

Abnormal swallowing movements are mainly manifested in four aspects:

1 dysfunction (slow start of swallowing, prolonged duration, disordered muscle activity and repeated swallowing, etc.);

2 pharyngeal crypt remains;

3 pharyngeal stasis;

4 aspiration (inhalation or laryngeal infiltration), more than half of patients have more than two abnormalities.

2. Pharyngeal and UES pressure measurement

The pharyngeal peristaltic contraction internal pressure can reach 400mmHg, the systolic pressure lasts 0.2~0.5s, and the conduction velocity is 9~25cm/s. The low compliance perfusion catheter system can record the change of pressure to evaluate the pharyngeal and UES activities. Apply a side hole recording device (including two micro sensors, one pharyngeal part, one measuring UES), placed 1.5cm at the lower end of the pharyngeal high pressure area, not only can correctly record the contraction of the swallowing sphincter, but also record the diastolic space Period, with the recorded static UES pressure, the approximation and termination of the pharyngeal contraction wave and the degree of relaxation and the coordination of UES and pharyngeal contraction, computer linear analysis can make a correct assessment of the dynamics of the pharyngeal pharynx.

3. Other

Esophagoscopy and direct laryngoscopy can examine the lower part of the pharynx, lesions of the USS and proximal esophagus, and radionuclides (liquid or solid food labeled with sputum) can quantify pharyngeal retention, reflux or tracheal inhalation, CT and MRI can To diagnose neurological diseases associated with oropharyngeal difficulty in the oropharynx, anticholinergic drugs are helpful in the study of myasthenia gravis hyperthyroidism (for the cause of difficulty in swallowing).

Diagnosis and diagnosis of circulatory dysfunction in the elderly

Abnormal circopharyngeal muscle function can lead to oropharyngeal dysphagia. If the clinical manifestations described above appear, the above-mentioned auxiliary examination can make a diagnosis.

Some patients have a cause to follow, should pay attention to identification.

1. UES closes in advance

That is, the throat muscle contracted earlier before the pharyngeal contraction was completed, and the UES was closed early, often accompanied by Zenker's diverticulum. X-ray and manometry were found to detect this abnormality, and others were found to be secondary to thyroid toxic myopathy or polymyositis.

2. UES delay is not complete

X-ray examination can find that the expectorant or group of food stays above the pharyngeal muscle. The pressure measurement of the UES pressure is normal, but it can not completely relieve the baseline pressure. It can be isolated or secondary to toxic thyroid myopathy and partial pharyngectomy. Postoperative or Parkinson's disease, etc.

3. UES relaxation delay

Margulies performed radiographic studies on 11 patients with familial autonomic dysfunction (dysautonomia or Riley-Day syndrome) and found that the pharyngeal muscles were completely open during the relaxation delay during swallowing, with a delay of >1/3s, often accompanied by trachea Aspiration.

4. The throat cannot be lifted and the UES cannot be opened.

Often secondary to neuromuscular abnormalities, X-ray examination can be found no activity in the throat, sphincter no opening, post-test check see UES pressure reduction.

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