Ausbildungscurriculum zum Zertifikat „Diagnostik und Therapie oropharyngealer Dysphagien, inklusive FEES“ der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie und der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Zusammenfassung

Hintergrund In Deutschland leiden ca. 5 Millionen Menschen jeden Lebensalters an einer Dysphagie. Durch den demografischen Wandel und die verbesserte medizinische Versorgung ist mit einer Zunahme der Inzidenz von Schluckstörungen zu rechnen. Die Dysphagie ist mit einer erhöhten Morbiditäts- und Mortalitätsrate assoziiert und führt zu einer erheblichen finanziellen Belastung der Gesundheitssysteme. Die zwei häufigsten Ursachen einer Schluckstörung sind neurologische Erkrankungen und Kopf-Hals-Tumore. Die Diagnostik und Therapie haben sich in den letzten Jahrzehnten kontinuierlich weiterentwickelt. Insbesondere die flexibel-endoskopische Beurteilung des Schluckaktes (FEES) ist zu einem festen Bestand in der Abklärung von Schluckstörungen geworden.

Ergebnisse Das Zertifikat „Diagnostik und Therapie oropharyngealer Dysphagien, inkl. FEES“ wurde von der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP) und der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO KHC) in Zusammenarbeit mit dem Deutschen Berufsverband für Phoniatrie und Pädaudiologie und dem Deutschen Berufsverband der Hals-Nasen-Ohrenärzte entwickelt.

Es besteht aus drei Teilen: den Modulen (A, B und C), der indirekten Supervision und einer praktischen Prüfung. Aufbau, detaillierte Inhalte und die Anforderungen zur Erlangung des Zertifikates werden im folgenden Artikel beschrieben. Ebenso werden die Qualifikationen der Dozenten und Prüfer festgesetzt.

Fazit Die systematische Ausbildung dient der Qualitätssicherung und Etablierung von Standards in der Diagnostik und Therapie von oropharyngealen Dysphagien in der Phoniatrie und Pädaudiologie und in der Hals-, Nasen- Ohrenheilkunde.

Abstract

Background In Germany, about 5 million people of all ages suffer from dysphagia. Due to demographic change and improved medical care, the incidence of swallowing disorders is expected to increase. Dysphagia is associated with an increased morbidity and mortality and leads to a considerable financial burden on the health systems. The two most common causes of dysphagia are neurological disorders and head and neck cancer. Diagnostics and therapy have developed continuously over the past decades. In particular, the flexible endoscopic evaluation of swallowing (FEES) has become an established part of dysphagia diagnostics.

Results The certificate “Diagnostics and Therapy of Oropharyngeal Dysphagia, incl. FEES” was developed by the German Society for Phoniatrics and Pedaudiology (DGPP) and the German Society for Otolaryngology, Head and Neck Surgery (DGHNO KHC) in cooperation with the German Professional Association for Phoniatrics and Pedaudiology and the German Professional Association of Otolaryngologists.

It consists of three parts: the modules (A, B and C), the indirect supervision and a practical examination. Structure, detailed contents and requirements for obtaining the certificate are described in the following article. The qualification of the lecturers and auditors are also defined.

Conclusion The systematic training serves the quality assurance and establishment of standards in the diagnostics and therapy of oropharyngeal dysphagia in the area of phoniatrics and ear, nose and throat medicine.

Schlüsselwörter

Oropharyngeale Dysphagie - FEES - Zertifikat - Schluckstörung - Endoskopie - Diagnostik - Ausbildung

Key words

Oropharyngeal dysphagia - FEES - Certificate - Swallowing disorder - Endoscopy - Diagnostics - Training

Fußnote

^* geteilte Letztautorenschaft

• Literatur

• 1 Logemann JA. Swallowing physiology and pathophysiology. Otolaryngol Clin North Am 1988; 21: 613-623
• 2 Horton J, Atwood C, Gnagi S. et al. Temporal Trends of Pediatric Dysphagia in Hospitalized Patients. Dysphagia 2018; 33: 655-661 doi:10.1007/s00455–018–9884–9
• 3 Benfer KA, Weir KA, Bell KL. et al. Oropharyngeal Dysphagia and Cerebral Palsy. Pediatrics 2017; 140 doi:10.1542/peds.2017–0731
• 4 Kuhn D, Miller S, Schwemmle C. et al. [Infantile swallowing]. Laryngorhinootologie 2014; 93: 231-236 doi:10.1055/s-0033–1355374
• 5 Muhle P, Suntrup-Krueger S, Wirth R. et al. [Swallowing in the elderly: Physiological changes, dysphagia, diagnostics and treatment]. Z Gerontol Geriatr. 2019 doi:10.1007/s00391–019–01540–4
• 6 Serra-Prat M, Hinojosa G, Lopez D. et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 2011; 59: 186-187 doi:10.1111/j.1532–5415.2010.03227.x
• 7 Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000–2007. Gerontology 2009; 55: 714-718 doi:10.1159/000235824
• 8 Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Seminars in speech and language 2000; 21: 347-361
• 9 Pflug C, Flugel T, Nienstedt JC. [Developments in dysphagia diagnostics : Presentation of an interdisciplinary concept]. Hno 2018; 66: 506-514 doi:10.1007/s00106–017–0433-x
• 10 Schefold JC, Berger D, Zurcher P. et al. Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial. Critical care medicine 2017; 45: 2061-2069 doi:10.1097/ccm.0000000000002765
• 11 Takizawa C, Gemmell E, Kenworthy J. et al. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease, Head Injury, and Pneumonia. Dysphagia 2016; 31: 434-441 doi:10.1007/s00455–016–9695–9
• 12 Kalf JG, de Swart BJ, Bloem BR. et al. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord 2012; 18: 311-315 doi:10.1016/j.parkreldis.2011.11.006
• 13 Pflug C, Bihler M, Emich K. et al. Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study. Dysphagia 2018; 33: 41-50 doi:10.1007/s00455–017–9831–1
• 14 Muller J, Wenning GK, Verny M. et al. Progression of dysarthria and dysphagia in postmortem-confirmed parkinsonian disorders. Arch Neurol 2001; 58: 259-264
• 15 Kuhnlein P, Gdynia HJ, Sperfeld AD. et al. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nature clinical practice Neurology 2008; 4: 366-374 doi:10.1038/ncpneuro0853
• 16 Reuschenbach M, Tinhofer I, Wittekindt C. et al. A systematic review of the HPV-attributable fraction of oropharyngeal squamous cell carcinomas in Germany. Cancer medicine. 2019 doi:10.1002/cam4.2039. doi:10.1002/cam4.2039
• 17 Pauloski BR, Rademaker AW, Logemann JA. et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck 2000; 22: 474-482
• 18 Rosen A, Rhee TH, Kaufman R. Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer. Archives of otolaryngology – head & neck surgery 2001; 127: 975-979
• 19 Rinkel RN, Verdonck-de Leeuw IM, Doornaert P. et al. Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 2016; 273: 1849-1855 doi:10.1007/s00405–015–3680-z
• 20 Carneiro D, das Gracas Wanderley de Sales Coriolano M, Belo LR. et al. Quality of life related to swallowing in Parkinson’s disease. Dysphagia 2014; 29: 578-582 doi:10.1007/s00455–014–9548–3
• 21 Tabor L, Gaziano J, Watts S. et al. Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2016; 31: 376-382 doi:10.1007/s00455–015–9686–2
• 22 Hong DG, Yoo DH. A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia. Journal of physical therapy science 2017; 29: 1552-1554 doi:10.1589/jpts.29.1552
• 23 Heijnen BJ, Speyer R, Kertscher B. et al. Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature. BioMed research international 2016; 2016: 6086894 doi:10.1155/2016/6086894
• 24 Schwarz M, Coccetti A, Murdoch A. et al. The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study. Journal of clinical nursing 2018; 27: e235-e241 doi:10.1111/jocn.13922
• 25 Feng MC, Lin YC, Chang YH. et al. The Mortality and the Risk of Aspiration Pneumonia Related with Dysphagia in Stroke Patients. J Stroke Cerebrovasc Dis. 2019 doi:10.1016/j.jstrokecerebrovasdis.2019.02.011. doi:10.1016/j.jstrokecerebrovasdis.2019.02.011
• 26 Buhmann C, Bihler M, Emich K. et al. Pill swallowing in Parkinson’s disease: A prospective study based on flexible endoscopic evaluation of swallowing. Parkinsonism & Related Disorders. 2019 doi:https://doi.org/10.1016/j.parkreldis.2019.02.002
• 27 Bonilha HS, Simpson AN, Ellis C. et al. The one-year attributable cost of post-stroke dysphagia. Dysphagia 2014; 29: 545-552 doi:10.1007/s00455–014–9543–8
• 28 Muehlemann N, Jouaneton B, de Leotoing L. et al. Hospital costs impact of post ischemic stroke dysphagia: Database analyses of hospital discharges in France and Switzerland. PLoS One 2019; 14: e0210313 doi:10.1371/journal.pone.0210313
• 29 Zuercher P, Moret CS, Dziewas R. et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Critical care (London, England) 2019; 23: 103 doi:10.1186/s13054–019–2400–2
• 30 Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia 2017; 32: 27-38 doi:10.1007/s00455–016–9775-x
• 31 Bajbouj M, Bartolome G, Graf S. et al. [Management of dysphagia--a multidsciplinary challenge]. MMW Fortschritte der Medizin 2011; 153: 46-48
• 32 Schroter-Morasch H, Graf S. [Swallowing examination for ENT specialists]. Hno 2014; 62: 324-334 doi:10.1007/s00106–014–2844–2
• 33 Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia 2008; 23: 244-250 doi:10.1007/s00455–007–9127-y
• 34 Trapl M, Enderle P, Nowotny M. et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38: 2948-2952 doi:10.1161/STROKEAHA.107.483933
• 35 O’Horo JC, Rogus-Pulia N, Garcia-Arguello L. et al. Bedside diagnosis of dysphagia: a systematic review. Journal of hospital medicine 2015; 10: 256-265 doi:10.1002/jhm.2313
• 36 Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 485-489
• 37 Kieser CW. [Introduction of cold light to endoscopy]. Aktuelle Urologie 2008; 39: 130-134 doi:10.1055/s-2007–980109
• 38 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2: 216-219
• 39 Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia 1998; 13: 19-21 doi:10.1007/pl00009544
• 40 Wu CH, Hsiao TY, Chen JC. et al. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope 1997; 107: 396-401
• 41 Onofri SM, Cola PC, Berti LC. et al. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia 2014; 29: 256-261 doi:10.1007/s00455–013–9504–7
• 42 Dziewas R, Glahn J, Helfer C. et al. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Med Educ 2016; 16: 70 doi:10.1186/s12909–016–0587–3
• 43 Dziewas R, Baijens L, Schindler A. et al. European Society for Swallowing Disorders FEES Accreditation Program for Neurogenic and Geriatric Oropharyngeal Dysphagia. Dysphagia 2017; 32: 725-733 doi:10.1007/s00455–017–9828–9
• 44 Arens C, Herrmann IF, Rohrbach S. et al. Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children. GMS Curr Top Otorhinolaryngol Head Neck Surg 2015; 14: Doc02 doi: 10.3205/cto000117. eCollection 2015. Review