What is a mastication?
act of chewing
Bolus:
a round mass, specifically a masticated lump of food ready to be swallowed
Aspiration:
entry of food or liquid into the airway below the true vocal folds
Penetration:
entry of food or liquid into the larynx at some level down to but not below the true vocal folds
PO:
per os (by mouth)
NPO
nil per os (nothing my mouth)
Who is affected by dysphagia?
Dysphagia can affect individuals across the lifespan, from newborns to the geriatric population.
What are some causes of dysphagia?
Dysphagia can result from various causes, including but not limited to congenital abnormalities, CVA (Cerebrovascular accident), tumors of the pharynx and larynx, progressive neurological diseases, and structural damage.
Signs and Symptoms
-Inability to recognize food
-Inability to control food or saliva in the mouth
-Coughing before, during, or after the swallow
-Frequent coughing toward the end of a meal or immediately after the meal
-Recurring pneumonia
-Weight loss when no other reason can be determined
-Gurgly vocal quality
-Increase in secretions in the pharynx and chest after a swallow, towards the end of a meal, or directly after a meal
-Patient complaints of swallowing difficulties
Complications of Dysphagia
-Pneumonia
-Malnutrition
-Dehydration
What is a common sign of dysphagia related to food recognition?
Inability to recognize food.
What is a symptom of dysphagia related to control of food or saliva in the mouth?
Inability to control food or saliva in the mouth.
When might coughing occur in relation to swallowing for someone with dysphagia?
Coughing may occur before, during, or after the swallow.
When does frequent coughing often occur for individuals with dysphagia?
Frequent coughing may occur toward the end of a meal or immediately after the meal.
What is a potential consequence of dysphagia that is related to the respiratory system?
Recurring pneumonia can be a result of dysphagia.
What is a possible outcome of dysphagia that can be observed in terms of body weight?
Weight loss may occur when no other reason can be determined.
What is a vocal symptom associated with dysphagia?
Gurgly vocal quality.
When can an increase in secretions in the pharynx and chest occur for individuals with dysphagia?
An increase in secretions may occur after a swallow, towards the end of a meal, or directly after a meal.
What is a common complaint expressed by patients with dysphagia?
Swallowing difficulties are often reported by patients.
Which healthcare professional specializes in evaluating and treating communication and swallowing disorders?
Speech Pathologist.
Which healthcare professional is involved in providing direct patient care and assisting with daily activities?
Nurse/CNA (Certified Nursing Assistant).
Who is responsible for providing nutrition assessment and dietary modifications for individuals with dysphagia?
Dietician.
Which healthcare professional focuses on improving functional abilities and independence in daily activities?
Occupational Therapist.
Who specializes in improving physical function, strength, and mobility?
Physical Therapist.
Who is responsible for dispensing and managing medications for dysphagia treatment?
Pharmacist.
Who interprets medical imaging studies, such as X-rays, to assess the anatomy and function of the swallowing mechanism?
Radiologist.
Which medical specialist focuses on disorders of the ear, nose, and throat, including those related to swallowing?
Otolaryngologist.
Which medical specialist focuses on disorders of the nervous system and may be involved in assessing and managing dysphagia?
Neurologist.
Who specializes in diagnosing and managing neurological disorders in children, including those that may affect swallowing?
Pediatric Neurologist.
Which medical specialist specializes in the evaluation and management of developmental disorders in children, including developmental delays that may impact swallowing?
Developmental Pediatrician.
Who is a physician specializing in physical medicine and rehabilitation, and may be involved in managing the functional aspects of dysphagia?
Physiatrist.
What can ultrasound be used to observe in relation to dysphagia?
Ultrasound can be used to observe tongue function, measure oral transit times, and assess the motion of the hyoid bone.
What are some limitations of ultrasound in imaging studies for dysphagia?
Ultrasound is unable to visualize the pharynx due to the presence of mixed tissue types, limiting its ability to provide a complete assessment of the swallowing process.
What is the history of videofluoroscopy in relation to dysphagia assessment?
Videofluoroscopy was developed in the 1930s and allowed for the examination of the oral cavity, pharynx, and esophagus during swallowing. The use of movie film known as cinefluorography enabled slow-motion and frame-by-frame viewing of the fluoroscopic image.
What are some disadvantages or limitations of videofluoroscopy?
Videofluoroscopy requires higher radiation exposure compared to other imaging methods, and the results are not immediately available for viewing.
What is the recent advancement in videofluoroscopy?
In recent years, videofluoroscopy studies have been recorded on video, allowing for better analysis and playback of the swallowing process. This feature is particularly important since the swallow occurs very quickly, typically lasting only 1-2 seconds.
What information can be obtained through videofluoroscopy?
Videofluoroscopy provides valuable information about the swallowing process, including bolus transit times, motility problems, and the amount and cause of aspiration. It allows for the visualization of the movement and coordination of the structures involved in swallowing, helping to identify any abnormalities or difficulties in the swallowing function.
What are the advantages of videofluoroscopy in assessing swallowing disorders?
Videofluoroscopy offers several benefits in the evaluation of swallowing disorders. It allows for the visualization of various aspects of the swallowing process, including mastication and the oral stage, the triggering of the pharyngeal swallow, and the motor aspects of the pharyngeal swallow. This provides valuable information about the coordination and movement of structures involved in swallowing. Additionally, videofluoroscopy can assess the effectiveness of treatment strategies, helping clinicians make informed decisions about intervention approaches. Another advantage is the ability to view the swallow from lateral and posterior-anterior perspectives, providing a comprehensive assessment of swallowing function.
What are some measurement scales used in Modified Barium Swallow Studies (MBS)?
-Penetration-Aspiration Scale(PAS), Rosenbek
PAS.pdf
-MBSImP
MBSImP | Modified Barium Swallow Impairment Profile
What are the advantages of using Videoendoscopy (FEES) for assessing swallowing disorders?
It allows for the examination of the anatomy of the oral cavity, pharynx, and larynx before and after the swallow.It enables the examination of the dynamics of velopharyngeal (VP) closure.
What are the limitations of Videoendoscopy (FEES) as an imaging study for swallowing disorders?
It cannot view the oral stage of the swallow.
It cannot view the swallow in real-time.
It can pose difficulties in defining the nature of physiological disorders and determining the effectiveness of treatment techniques.
What is Scintigraphy?
Scintigraphy is a nuclear medicine test where patients swallow measured amounts of radioactive material, and during the swallow, the bolus is imaged and recorded by a gamma camera.
What are the pros of Scintigraphy?
It allows for the measurement of the amount of aspiration and residue during swallowing.
It is diagnostic for esophageal aspects of swallowing disorders, such as gastroesophageal reflux disease (GERD).
It is helpful for research purposes.
What are the cons of Scintigraphy?
It exposes the patient to radiation.
It has limited visualization of anatomical structures involved in swallowing.
It may have difficulty in assessing certain aspects of swallowing function.
It requires specialized equipment and expertise.
What are the cons of Scintigraphy?
The physiology of the oral cavity and pharynx is not visualized during the test.
It is unable to identify disorders that cause residue and aspiration.
What is the purpose of Electromyography (EMG) in the evaluation of dysphagia?
Electromyography (EMG) can provide information on the timing and relative amplitude of muscle contractions during swallowing. It is also used as a biofeedback technique for dysphagia therapy.
What is the purpose of Electroglottography in the evaluation and treatment of dysphagia?
Electroglottography is used to track the movement of the vocal folds by recording impedance changes as they move during phonation. It can also track laryngeal elevation and provide biofeedback for treatment purposes in dysphagia.
What is the purpose of cervical auscultation in the evaluation of swallowing and respiration
Cervical auscultation is used to assess swallowing and respiration. For swallowing, it involves using acoustics parameters such as a small microphone, accelerometer, or a stethoscope to detect specific sounds during the swallow, such as the "click" of the opening of the eustachian tube and the "clunk" of the opening of the upper esophageal sphincter (UES). For respiration, cervical auscultation helps define the inhalatory and exhalatory phases and determines the phase in which the pharyngeal swallow occurs. It can also assess secretion levels before and after the swallow.
What can be measured using pharyngeal manometry in the evaluation of swallowing?
Pharyngeal manometry is a technique used to measure various aspects of swallowing. It can measure pressure changes during the pharyngeal swallow, providing information about the coordination and strength of muscle contractions involved in swallowing. It can also measure intrabolus pressures, which helps assess the pressure exerted on the bolus during swallowing. Pharyngeal manometry is also used to measure the pharyngeal contractile wave, which is the coordinated movement of the pharyngeal muscles during swallowing. Additionally, it provides an indirect examination of the relaxation of the cricopharyngeus muscle, which is important for the opening and closing of the upper esophageal sphincter.