Swallowing Therapy for Systemic Amyloidosis-induced Dysphagia: A Case Report

類澱粉沉積症併發吞嚥困難之吞嚥治療：病例報告

吳宜賢(I-Hsien Wu) ； 陳璟綺(Ching-Chi Chen) ； 吳美宜(Mei-Yi Wu) ； 董莉貞(Li-Chen Tung) ； 劉榮泰(Jung-Tai Liu)

《台灣復健醫學雜誌》 39卷1期 (2011/03) Pp. 25-29

https://doi.org/10.6315/2011.39(1)04

摘要

類澱粉沉積症是一種fibrillar protein沉積在細胞外的疾病，會影響全身的器官與組織。臨床表現爲心肌病變、肝腫大、蛋白尿、巨舌症及吞嚥困難等症狀。本病例報告一位診斷爲類澱粉沉積症併有多發性骨髓癌的52歲男性，導致巨舌症及日見嚴重的吞嚥困難和發聲困難，轉介到復健科尋求治療。經X光透視螢光錄影吞嚥檢查發現，舌頭動作協調性差、食糰殘留在會厭鼓竇(valleculae)及梨狀竇(pyriform sinus)、明顯的嗆食(aspiration)現象。病人接受了六個月吞嚥訓練，包括擺位練習，加強聲帶閉合，上聲門吞嚥法(supraglottic swallow)及孟德森吞嚥法(Mendelsohn maneuver)等治療方式，已經可自行吃流質或軟質食物而沒有嗆到的情形。針對此病例若能完整評估吞嚥功能及給予適當的吞嚥訓練，應有助於改善吞嚥功能及生活品質。

關鍵字

類澱粉沉積症 ； 巨舌症 ； 吞嚥困難 ； 吞嚥治療

並列摘要

Amyloidosis is defined as the extracellular deposition of fibrillar proteins in different organs and tissues. The clinical features of amyloidosis include cardiomyopathy, hepatomegaly, proteinuria, macroglossia, and dysphagia. We report the case of a 52-year-old man with myeloma-associated amyloidosis who complained of progressive dysphagia, dysarthria, and macroglossia. Videofluoroscopic swallowing study revealed severe reduction in tongue movements, aspiration after swallowing, and retention in the valleculae and pyriform sinuses. The patient underwent swallowing therapy for 6 months; the therapy included compensatory neck flexion, vocal cord adduction exercises, supraglottic swallow, and the Mendelsohn maneuver. The swallowing therapy enabled the patient to swallow liquid and soft solids without choking. Thus, swallowing therapy is helpful and improves the quality of life of patients with severe dysphagia induced by amyloidosis.

並列關鍵字

amyloidosis ； macroglossia ； dysphagia ； swallowing therapy