VOICE AND SWALLOWING CLINIC
DR MUKUNDAN SUBRAMANIAN
SWALLOWING ASSESSMENT
Mr Sekhar 65 year old male was admitted at St Isabels Hospital in March 2021 for Acute Right Fronto
temporal SDH- midline shift for which tracheotomy was done on 23/3 /21 and he was discharged on
April 21. Tracheostomy decanulation was done on 12 June 2021.
Date of Assessment: 23 June 2021
Patient is on total oral diet with no restrictions (FOIS Level 7).
He complains of cough while taking liquids and difficulty in swallowing solid food.
On examination he is conscious, cooperative and well oriented to time place and person. Vitals are
stable.
Clinical Swallow Evaluation:
His lip closure, lingual control and mastication appears to be normal.
Orodental hygiene is very poor with most teeth decayed along with tartar and plaque.
Respiratory system examination is within normal limits. Phonation is Normal. Tracheostomy stoma is
closed and well healed.
Flexible Endoscopic Evaluation of Swallowing:
The patient has a right sided nasal bone fracture with a gross DNS to right side.
Nasopharynx normal structure and function.
Pharynx and Larynx: No laryngeal/ pharyngeal palsy.
Secretions present in vallecula : ( Murray Stage I) ( Yale Stage II)
Trials with 10 ml and 20 ml water:
No evidence of premature spillage/ vallecular residue/ PFS residue. No evidence of penetration or
aspiration of thin liquids.
With biscuit 3 trials- there was evidence of Moderate ( 25-50% epiglottic ligament covered) vallecular
Residue.
PAS Score 2- material reaches level of epiglottis but is ejected out on one trial out of 3 trials.
The vallecular residue was cleared by liquid wash, effortful swallow and chin tuck maneuver.
Contributing Factors to swallowing impairment :
Poor oro- dental hygiene
Impaired BOT Retraction
VOICE AND SWALLOWING CLINIC
DR MUKUNDAN SUBRAMANIAN
SWALLOWING ASSESSMENT
Nutrition:
Has lost > 15 kg in last 4 months
Present weight 45 kg ,BMI :15.6
MNA- Sf 4 points: Malnoursihed
Diagnosis: Oropharyngeal Dysphagia- Moderate – neurogenic cause.
Poor orodental hygiene
Risk for inadequate nutrition
Recommendations:
Orodental hygiene:
To consult with Dentist regarding Cleaning
Brush twice daily and before and after meals
Nutrition:
Refer to dietician
Diet texture: Regular diet: Solids/ Liquids
Small sips and bites while eating
Alternate solids and liquids
Supervise all meals
Upright position at least 30 minutes after meals
Clear throat every 2-3 bites or sips
Compensatory strategies while eating:
1. Chin tuck:
HOLD FOOD/ DRINK IN YOUR MOUTH
LOOK DOWN ON YOU LAP WITH YOUR CHIN ON THE CHEST
SWALLOW
VOICE AND SWALLOWING CLINIC
DR MUKUNDAN SUBRAMANIAN
SWALLOWING ASSESSMENT
2. Effortful swallow
SWALLOW AS HARD AS YOU CAN WHEN READY
SWALLOWING EXERCISE:
MASAKO:
Stick out your tongue
Gently bite down on the tip of your tongue
Swallow saliva while you hold tongue out between your teeth
Pull your tongue back in your mouth.
Repeat 10 times each day three times a day
Review after 10 days.