Tesis

Gambaran Pemeriksaan Flexible Endoscopic Evaluation Of Swallowing (FEES) Sebelum dan Setelah Tatalaksana Disfagia Di RS Cipto Mangunkusumo Periode Januari ̶Desember 2023 = Overview of Flexible Endoscopic Evaluation of Swallowing (FEES) Before and After Dysphagia Management at Cipto Mangunkusumo Hospital for the Period January ̶December 2023.

Latar Belakang : Disfagia dapat dialami oleh semua usia dan disebabkan oleh berbagai penyakit, kelainan bawaan, atau kerusakan struktural. Penanganan disfagia memerlukan pendekatan multidisiplin, dan diagnosis sering dilakukan menggunakan Flexible Endoscopic Evaluation of Swallowing (FEES). Namun, data profil pasien disfagia di Indonesia masih terbatas dan cenderung fokus pada penyebab spesifik. Oleh karena itu, penelitian ini bertujuan untuk mendapatkan data karakteristik pasien disfagia, status nutrisi, serta gambaran hasil pemeriksaan FEES sebelum dan setelah tatalaksana disfagia di RS Cipto Mangunkusumo. Tujuan : Mengetahui karakteristik pasien disfagia, status nutrisi, serta gambaran proses menelan berdasarkan preswallowing assessment dan swallowing assessment pasien disfagia yang datang ke poli THT bronkoesofagologi RSCM periode Januari hingga Desember 2023. Metode : Penelitian ini merupakan studi potong lintang dari 52 subjek, data yang diambil berupa data sekunder rekam medik elektronik. Hasil : Karakteristik subjek disfagia yang paling banyak ditemukan adalah kelompok usia 45 ̶59 tahun (40,4%), jenis kelamin laki-laki (53,8%), status gizi normal (50%), keluhan tersering tersedak (19,5%) dengan penyakit dasar kelainan susunan saraf pusat (46,2%), onset keluhan 1 ̶ 3 bulan (48,1%), FEES pertama kali (76,9%), terapi rehabilitasi medik 6 ̶12 kali (44,2%). Klasifikasi disfagia terbanyak disfagia neurogenik (90,4%), fase orofaring (88,5%), derajat berat (65,4%), dengan asupan via NGT (61,5%). Gambaran preswallowing assessment FEES 1 dan FEES 2 berupa lip seal baik (96,2%) dan (96,2%), velofaring baik (92,3%) dan (98%), tidak ada post nasal drip (90,4%) dan (96,2%), tonsil lingua derajat I (40,4%) dan (40,4%), pita suara simetris (73,1%) dan (82,7%), adanya standing secretion (92,3%) dan (84,6%) dengan skor terbanyak MSS 3 pada FEES awal (40,4%) dan MSS 1 pada FEES evaluasi (32,7%), adanya penetrasi (50%) dan (28,8%), aspirasi (34,6%) dan (11,5%). Touch test positif (55,8%) dan (65,4%), pharyngeal squeeze positif (67,3%) dan (94,2%). Pada swallowing assessment FEES awal, leakage terbanyak pada puree (73,2%), penetrasi dan aspirasi pada thin liquid (68,7%) dan (50%). Puree, gastric rice, havermout dan thick liquid memiliki skala terbanyak PAS 1 (43.9%), (55,5%), (57,7%) dan (46,7%). Skala PAS terbanyak Thin liquid PAS 8 (40,5%). Pada FEES awal, Skor Yale I di valekula dan sinus piriformis terbanyak pada konsistensi thin liquid (53,1%) dan (56,2%). Pada swallowing assessment FEES evaluasi, leakage terbanyak pada havermout (65%), penetrasi pada thick liquid (48,8%) dan aspirasi pada thin liquid (28,6%). Puree, gastric rice, havermout thick liquid dan thin liquid memiliki skala PAS 1 terbanyak (66,7%), (68,3%), (60%), (51 ,2%) dan (57,1%). Skor Yale I di valekula dan sinus piriformis terbanyak pada konsistensi thin liquid (59,5%) dan (61 ,9%) Kesimpulan : Mayoritas pasien merupakan kelompok usia 45 ̶59 tahun sebanyak 40,4%, dengan perbandingan jenis kelamin laki-laki terhadap perempuan sebesar 1.3:1 , kelainan susunan saraf pusat sebagai penyakit terbanyak yang ditemukan pada pasien disfagia (46,2%). Status gizi normal terbanyak ditemukan pada pasien disfagia, sebesar 50%. Kejadian disfungsi velofaring, standing secretion, penetrasi dan aspirasi mengalami penurunan pada preswallowing assessment FEES evaluasi serta peningkatan kejadian respon touch test, pharyngeal squeeze, dan kesimetrisan gerakan pita suara. Kejadian leakage, residu, penetrasi, aspirasi dan silent aspirasi mengalami penurunan pada swallowing assessment FEES evaluasi.
Kata kunci : aspirasi, disfagia, FEES, penetrasi, residu, standing secretion, tes menelan.


Background: Dysphagia can be experienced by individuals of all ages and can be caused by various diseases, congenital disorders, or structural damage. Managing dysphagia requires a multidisciplinary approach, and diagnosis is often performed using Flexible Endoscopic Evaluation of Swallowing (FEES). However, patient profile data on dysphagia in Indonesia is still limited and tends to focus on specific causes. Therefore, this study aims to obtain data on the characteristics of dysphagia patients, their nutritional status, and the FEES examination results before and after dysphagia management at RSUPN Dr. Cipto Mangunkusumo. Objective: To understand the characteristics of dysphagia patients, their nutritional status, and the swallowing process based on preswallowing assessment and swallowing assessment of dysphagia patients who visited the ENT bronchoesophagology clinic at RSCM from January to December 2023. Method: This research is a cross-sectional study of 52 subjects, with data collected in the form of secondary data from electronic medical records. Results: The most common characteristics of dysphagia subjects were the age group of 45 ̶59 years (40, 4%), male gender (53, 8%), normal nutritional status (50%), the most frequent complaint was choking (19, 5%) with underlying disease being central nervous system disorders (46,2%), onset of complaints 1 ̶3 months (48, 1%), first-time FEES (76, 9%), and medical rehabilitation therapy 6 ̶12 times (44, 2%). The most common classification of dysphagia was neurogenic dysphagia (90, 4%), oropharyngeal phase (88, 5%), severe degree (65,4%), with intake via NGT (61, 5%). The preswallowing assessment for FEES 1 and FEES 2 showed good lip seal (96, 2%) and (96, 2%), good velopharyngeal function (92, 3%) and (98%), no post nasal drip (90, 4%) and (96, 2%), grade I lingual tonsils (40, 4%) and (40,4%), symmetrical vocal cords (73, 1%) and (82, 7%), presence of standing secretion (92, 3%) and (84, 6%) with the most common MSS score being 3 at initial FEES (40, 4%) and MSS 1 at evaluation FEES (32, 7%), presence of penetration (50%) and (28, 8%), aspiration (34,6%) and (11, 5%). Positive touch test (55, 8%) and (65, 4%), positive pharyngeal squeeze (67, 3%) and (94, 2%). In the initial swallowing assessment FEES, the most leakage occurred with puree (73, 2%), penetration and aspiration with thin liquid (68, 7%) and (50%). Puree, gastric rice, oatmeal, and thick liquid had the most PAS 1 scores (43, 9%), (55, 5%), (57, 7%) and (46, 7%). The most common PAS scale for thin liquid was PAS 8 (40, 5%). In the initial FEES, the highest Yale I score in the vallecula and piriform sinuses was with thin liquid consistency (53, 1%) and (56, 2%). In the evaluation swallowing assessment FEES, the most leakage occurred with oatmeal (65%), penetration with thick liquid (48, 8%), and aspiration with thin liquid (28, 6%). Puree, gastric rice, oatmeal, thick liquid, and thin liquid had the most PAS 1 scores (66, 7%), (68, 3%), (60%), (51, 2%), and (57,1%). The highest Yale I score in the vallecula and piriform sinuses was with thin liquid consistency (59, 5%) and (61, 9%). Conclusion: The majority of patients were in the 45 ̶59 age group, accounting for 40, 4%, with a maleto-female ratio of1.3:1. Central nervous system disorders were the most common underlying disease found in dysphagia patients, at 46, 2%. Normal nutritional status was the most commonly found among dysphagia patients, at 50%. The incidence of velopharyngeal dysfunction, standing secretion, penetration, and aspiration decreased in the preswallowing assessment of the evaluation FEES, while the incidence of positive touch test, pharyngeal squeeze, and symmetrical vocal cord movement increased. The occurrences of leakage, residue, penetration, aspiration, and silent aspiration decreased in the swallowing assessment of the evaluation FEES.
Kerywords : aspiration, dysphagia, Flexible Endoscopic Evaluation of Swallowing, penetration, residue, swallowing test, standing secretion.