Oropharyngeal dysphagia
Encyclopedia
Swallowing disorders can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions. Swallowing problems are a common complaint
among older individuals, and the incidence
of dysphagia is higher in the elderly, in patients who have had stroke
s, and in patients who are admitted to acute care hospitals or chronic care
facilities. Other causes of dysphagia include head and neck cancer
and progressive neurologic diseases like Parkinson's disease
, Dementia
, Multiple sclerosis
, Multiple system atrophy
, or Amyotrophic lateral sclerosis
. Dysphagia is a symptom of many different causes, which can usually be elicited by a careful history
by the treating physician
. A formal oropharyngeal dysphagia evaluation is performed by a speech-language pathologist.
Dysphagia is classified into two major types: oropharyngeal dysphagia and esophageal dysphagia
. In some patients, no organic cause for dysphagia can be found, and these patients are defined as having functional dysphagia.
Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper esophageal sphincter.
, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck patients will often point to the cervical (neck
) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.
, malnutrition
, or dehydration
.
is sometimes administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally.
A patient needing further investigation will most likely receive a Modified Barium swallow (MBS). Different consistencies of liquid and food mixed with barium
sulfate are fed to the patient by spoon, cup or syringe, and x-rayed using videofluoroscopy. A patient's swallowing then can be evaluated and described. Some clinicians might choose to describe each phase of the swallow in detail, making mention of any delays or deviations from the norm. Others might choose to use a rating scale such as the Penetration Aspiration Scale. The scale was developed to describe the disordered physiology of a person's swallow using the numbers 1-8. Other scales also exist for this purpose.
A patient can also be assessed using videoendoscopy, also known as flexible fiberoptic endoscopic examination of swallowing (FFEES). The instrument is placed into the nose until the clinician can view the pharynx
and then he or she examines the pharynx and larynx
before and after swallowing. During the actual swallow, the camera is blocked from viewing the anatomical structures. A rigid scope, placed into the oral cavity to view the structures of the pharynx and larynx, can also be used, though this prevents the patient from swallowing.
Other less frequently used assessments of swallowing are imaging studies, ultrasound
and scintigraphy
and nonimaging studies, electromyography
(EMG), electroglottography (EGG)(records vocal fold movement), cervical auscultation
, and pharyngeal manometry
.
Postural techniques.
Swallowing Maneuvers.
Diet modifications
Diet modification may be warranted. Some patients require a soft diet
that is easily chewed, and some require liquids of a thinned or thickened consistency
.
Environmental modifications
Environmental modification can be suggested to assist and reduce risk factors for aspiration. For example: having the patient use a straw while drinking liquids, putting a pillow behind the patient's head during feeding, removing distractors like too many people in the room or turning off the TV during feeding, etc.
Oral sensory awareness techniques
Oral sensory awareness techniques can be used with patients who have a swallow apraxia, tactile agnosia
for food, delayed onset of the oral swallow, reduced oral sensation, or delayed onset of the pharyngeal swallow.
Electrical stimulation
Electrical stimulation (E-stim) is targeted for oropharyngeal dysphagia and uses electrical stimulation to retrain the muscles used in swallowing and facilitate voluntary swallowing activity. This type of therapy has been used in a clinical setting for many years in Physical Therapy. Its use for oropharyngeal dysphagia has received much attention in recent years and is now the most researched treatment intervention in dysphagia therapy.
Prosthetics
Surgical treatments
These are usually only recommended as a last resort.
Complaint
In legal terminology, a complaint is a formal legal document that sets out the facts and legal reasons that the filing party or parties In legal terminology, a complaint is a formal legal document that sets out the facts and legal reasons (see: cause of action) that the filing party or parties In...
among older individuals, and the incidence
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of dysphagia is higher in the elderly, in patients who have had stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
s, and in patients who are admitted to acute care hospitals or chronic care
Chronic care
Chronic care refers to medical care which addresses preexisting or long term illness, as opposed to acute care which is concerned with short term or severe illness of brief duration. Chronic medical conditions include, but are not limited to, asthma, emphysema, chronic bronchitis, congestive heart...
facilities. Other causes of dysphagia include head and neck cancer
Head and neck cancer
Head and neck cancer refers to a group of biologically similar cancers that start in the upper aerodigestive tract, including the lip, oral cavity , nasal cavity , paranasal sinuses, pharynx, and larynx. 90% of head and neck cancers are squamous cell carcinomas , originating from the mucosal lining...
and progressive neurologic diseases like Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
, Dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, Multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, Multiple system atrophy
Multiple system atrophy
Multiple system atrophy is a degenerative neurological disorder. MSA is associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance and other autonomic functions of the body such as bladder control or blood pressure...
, or Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...
. Dysphagia is a symptom of many different causes, which can usually be elicited by a careful history
History
History is the discovery, collection, organization, and presentation of information about past events. History can also mean the period of time after writing was invented. Scholars who write about history are called historians...
by the treating physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
. A formal oropharyngeal dysphagia evaluation is performed by a speech-language pathologist.
Dysphagia is classified into two major types: oropharyngeal dysphagia and esophageal dysphagia
Esophageal dysphagia
Esophageal dysphagia arises from the body of the esophagus, lower esophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problems.-Symptoms, signs, and evaluation:...
. In some patients, no organic cause for dysphagia can be found, and these patients are defined as having functional dysphagia.
Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper esophageal sphincter.
Signs and symptoms
Some signs and symptoms of swallowing difficulties include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumoniaPneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck patients will often point to the cervical (neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.
Complications
If left untreated, swallowing disorders can potentially cause aspiration pneumoniaAspiration pneumonia
Aspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree, usually oral or gastric contents...
, malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, or dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
.
Etiology and differential diagnosis
- A strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
can cause pharyngeal dysfunction with a high occurrence of aspiration. The function of normal swallowingSwallowingSwallowing, known scientifically as deglutition, is the process in the human or animal body that makes something pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. If this fails and the object goes through the trachea, then choking or pulmonary aspiration...
may or may not return completely following an acute phase lasting approximately 6 weeks. - Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
can cause "multiple prepharyngeal, pharyngeal, and esophageal abnormalities". The severity of the disease most often correlates with the severity of the swallowing disorder. - Neurologic disorders such as strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
, amyotrophic lateral sclerosisAmyotrophic lateral sclerosisAmyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...
, Bell's palsyBell's palsyBell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII that results in the inability to control facial muscles on the affected side. Several conditions can cause facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause...
, or myasthenia gravisMyasthenia gravisMyasthenia gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatiguability...
can cause weakness of facial and lip muscles that are involved in coordinated mastication as well as weakness of other important muscles of mastication and swallowing. - Oculopharyngeal muscular dystrophyOculopharyngeal muscular dystrophyOculopharyngeal muscular dystrophy is an autosomal dominant neuromuscular disease which appears in early middle age . OPMD is an example of a trinucleotide repeat disorder caused by expanding 10 to 11-17 at the 5' end of the coding region for PABPN1...
is a genetic disease with palpebral ptosisPtosis (eyelid)Ptosis is a drooping of the upper or lower eyelid. The drooping may be worse after being awake longer, when the individual's muscles are tired. This condition is sometimes called "lazy eye", but that term normally refers to amblyopia...
, oropharyngeal dysphagia, and proximal limb weakness. - Decrease in salivary flow, which can lead to dry mouth or xerostomiaXerostomiaXerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...
, can be due to Sjogren's syndromeSjögren's syndromeSjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
, anticholinergics, antihistamines, or certain antihypertensives and can lead to incomplete processing of food bolus. - XerostomiaXerostomiaXerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...
can reduce the volume and increase the viscosityViscosityViscosity is a measure of the resistance of a fluid which is being deformed by either shear or tensile stress. In everyday terms , viscosity is "thickness" or "internal friction". Thus, water is "thin", having a lower viscosity, while honey is "thick", having a higher viscosity...
of oral secretions making bolusBolus (digestion)In digestion, a bolus is a mass of food that has been chewed at the point of swallowing. Once a bolus reaches the stomach, digestion begins....
formation difficult as well as reducing the ability to initiate and swallow the bolus - Dental problems can lead to inadequate chewing.
- Abnormality in oral mucosa such as from mucositisMucositisMucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to the particular...
, aphthous ulcers, or herpetic lesionsHerpes simplex virusHerpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
can interfere with bolusBolus (digestion)In digestion, a bolus is a mass of food that has been chewed at the point of swallowing. Once a bolus reaches the stomach, digestion begins....
processing. - Mechanical obstruction in the oropharynx may be due to malignancies, cervical rings or webs, crico-phyringeus muscle dysfunction, or cervical osteophytes.
- Increased upper esophageal sphincter tone can be due to Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
which leads to incomplete opening of the UES. This may lead to formation of a Zenker's diverticulumZenker's diverticulumIn anatomy, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle...
. - Pharyngeal pouchPharyngeal pouchPharyngeal pouch can refer to:* Zenker's diverticulum* Pharyngeal pouch...
es typically cause difficulty in swallowing after the first mouthful of food, with regurgitation of the pouch contents. These pouches may be accompanied by malodorous breath due to decomposing foods residing in the pouches. (See Zenker's diverticulumZenker's diverticulumIn anatomy, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle...
) - Dysphagia is often a side effect of surgical procedures like anterior cervical spine surgery, carotid endarterectomyCarotid endarterectomyCarotid endarterectomy is a surgical procedure used to prevent stroke, by correcting stenosis in the common carotid artery...
, head and neck resection, oral surgeries like removal of the tongue, and parital laryngectomies - Radiotherapy, used to treat head and neck cancer, can cause tissue fibrosisFibrosisFibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
in the irradiated areas. Fibrosis of tongueTongueThe tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
and larynxLarynxThe larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
lead to reduced tongue base retraction and laryngeal elevation during swallowing - Infection may cause pharyngitisPharyngitisPharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
which can prevent swallowing due to painPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
. - Medications can cause central nervous systemCentral nervous systemThe central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
effects that can result in swallowing disorders and oropharyngeal dysphagia. Examples: sedatives, hypnotic agents, anticonvulsants, antihistamines, neuroleptics, barbiturates, and antiseizure medication. Medications can also cause peripheral nervous systemPeripheral nervous systemThe peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...
effects resulting in an oropharyngeal dysphagia. Examples: corticosteroids, L-tryptophan, and anticholinergics
Assessment of adults
A Speech Language Pathologist or other trained medical professional may be called upon to evaluate a patient who complains of dysphagia. During this initial examination a medical history is obtained, the mini-mental state examinationMini-mental state examination
The mini–mental state examination or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia...
is sometimes administered, and oral and facial sensorimotor function, speech, and swallowing are evaluated non-instrumentally.
A patient needing further investigation will most likely receive a Modified Barium swallow (MBS). Different consistencies of liquid and food mixed with barium
Barium
Barium is a chemical element with the symbol Ba and atomic number 56. It is the fifth element in Group 2, a soft silvery metallic alkaline earth metal. Barium is never found in nature in its pure form due to its reactivity with air. Its oxide is historically known as baryta but it reacts with...
sulfate are fed to the patient by spoon, cup or syringe, and x-rayed using videofluoroscopy. A patient's swallowing then can be evaluated and described. Some clinicians might choose to describe each phase of the swallow in detail, making mention of any delays or deviations from the norm. Others might choose to use a rating scale such as the Penetration Aspiration Scale. The scale was developed to describe the disordered physiology of a person's swallow using the numbers 1-8. Other scales also exist for this purpose.
A patient can also be assessed using videoendoscopy, also known as flexible fiberoptic endoscopic examination of swallowing (FFEES). The instrument is placed into the nose until the clinician can view the pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
and then he or she examines the pharynx and larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
before and after swallowing. During the actual swallow, the camera is blocked from viewing the anatomical structures. A rigid scope, placed into the oral cavity to view the structures of the pharynx and larynx, can also be used, though this prevents the patient from swallowing.
Other less frequently used assessments of swallowing are imaging studies, ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
and scintigraphy
Scintigraphy
Scintigraphy is a form of diagnostic test used in nuclear medicine, wherein radioisotopes are taken internally, and the emitted radiation is captured by external detectors to form two-dimensional images...
and nonimaging studies, electromyography
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
(EMG), electroglottography (EGG)(records vocal fold movement), cervical auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
, and pharyngeal manometry
Manometry
Manometry refers to the evaluation of pressure .Forms include:* Esophageal motility study* Anorectal manometry* Rhinomanometry...
.
Treatment
After assessment, a Speech Language Pathologist will determine the safety of the patient's swallow and recommend treatment accordingly. The Speech Language Pathologist will also advise staff/caregivers and give information about what signs to look for to know if the client is aspirating (e.g. coughing, choking, voice quality becoming 'wet' or 'gurgly', chest colds, recurrent pneumonia) and feeding instructions if required, including posture while eating, consistency of food, and size of mouthfuls.Postural techniques.
- Head back (extension) – used when movement of the bolus from the front of the mouth to the back is inefficient; this allows gravity to help move the food.
- Chin down (flexion) – used when there is a delay in initiating the swallow; this allows the valleculae to widen, the airway to narrow, and the epiglottis to be pushed towards the back of the throat to better protect the airway from food.
- Chin down (flexion) – used when the back of the tongue is too weak to push the food towards the pharynx; this causes the back of the tongue to be closer to the pharyngeal wall.
- Head rotation (turning head to look over shoulder) to damaged or weaker side with chin down – used when the airway is not protected adequately causing food to be aspiratedPulmonary aspirationPulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract...
; this causes the epiglottis to be put in a more protective position, it narrows the entrance of the airway, and it increases vocal fold closure. - Lying down on one side – used when there is reduced contraction of the pharynx causing excess residue in the pharynx; this eliminates the pull of gravity that may cause the residue to be aspirated when the patient resumes breathing.
- Head rotation to damaged or weaker side – used when there is paralysisParalysisParalysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
or paresisParesisParesis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...
on one side of the pharyngeal wall; this causes the bolus to go down the stronger side. - Head tilt (ear to shoulder) to stronger side – used when there is weakness on one side of the oral cavity and pharyngeal wall; this causes the bolus to go down the stronger side.
Swallowing Maneuvers.
- Supraglottic swallow - The patient is asked to take a deep breath and hold their breath. While still holding their breath they are to swallow and then immediately cough after swallowing. This technique can be used when there is reduced or late vocal fold closure or there is a delayed pharyngeal swallow.
- Super-supraglottic swallow - The patient is asked to take a breath, hold their breath tightly while bearing down, swallow while still holding the breath hold, and then coughing immediately after the swallow. This technique can be used when there is reduced closure of the airway.
- Effortful swallow - The patient is instructed to squeeze their muscles tightly while swallowing. This may be used when there is reduced posterior movement of the tongue base.
- Mendelsohn maneuver - The patient is taught how to hold their adam's appleAdam's appleThe laryngeal prominence—commonly known as the Adam's Apple—is a feature of the human neck. This lump, or protrusion, is formed by the angle of the thyroid cartilage surrounding the larynx...
up during a swallow. This technique may be used when there is reduced laryngeal movement or a discoordinated swallow.
Diet modifications
Diet modification may be warranted. Some patients require a soft diet
Soft diet
A soft diet is recommended in many situations, including some types of dysphagia , surgery involving the jaw, mouth or gastrointestinal tract, and pain from newly adjusted dental braces....
that is easily chewed, and some require liquids of a thinned or thickened consistency
Thickened fluids
Thickened fluids are often used for people with dysphagia, a disorder of swallowing function. The thicker consistency makes it less likely that an individual with dysphagia will aspirate while they are drinking...
.
Environmental modifications
Environmental modification can be suggested to assist and reduce risk factors for aspiration. For example: having the patient use a straw while drinking liquids, putting a pillow behind the patient's head during feeding, removing distractors like too many people in the room or turning off the TV during feeding, etc.
Oral sensory awareness techniques
Oral sensory awareness techniques can be used with patients who have a swallow apraxia, tactile agnosia
Agnosia
Agnosia is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss...
for food, delayed onset of the oral swallow, reduced oral sensation, or delayed onset of the pharyngeal swallow.
- pressure of a spoon against tongue
- using a sour bolus
- using a cold bolus
- using a bolus that requires chewing
- using a bolus larger than 3mL
- thermal-tactile stimulation (controversial)
Electrical stimulation
Electrical stimulation (E-stim) is targeted for oropharyngeal dysphagia and uses electrical stimulation to retrain the muscles used in swallowing and facilitate voluntary swallowing activity. This type of therapy has been used in a clinical setting for many years in Physical Therapy. Its use for oropharyngeal dysphagia has received much attention in recent years and is now the most researched treatment intervention in dysphagia therapy.
Prosthetics
- Palatal liftPalatal liftA palatal lift prosthesis is a prosthesis that addresses a condition referred to as palatopharyngeal incompetence. Palatopharyngeal incompetence broadly refers to a muscular inability to sufficiently close the port between the nasopharynx and oropharynx during speech and/or swallowing...
or Palatal obturatorPalatal obturatorA palatal obturator is a prosthesis that totally occludes an opening such as an orinasal fistula . They are similar to dental retainers, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard/soft palate that may affect speech... - Maxillary denture
Surgical treatments
These are usually only recommended as a last resort.
- TracheotomyTracheotomyAmong the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
- Tracheostomy
- Vocal fold augmentation/injection
- Thryoplasty medialization
- Arytenoid adduction
- Partial or total laryngectomyLaryngectomyLaryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. The laryngectomee breathes through an opening in the neck, a stoma. This procedure is usually performed in cases of laryngeal cancer...
- Laryngotracheal separation
- Supralaryngectomy
- PalatoplastyPalatoplastyPalatoplasty is a surgical procedure used to correct or reconstruct the palate in a person with a cleft palate. The basic goals of the procedure are to close the abnormal opening between the nose and mouth, to help the patient develop normal speech, and to aid in swallowing, breathing and normal...
- Cricopharyngeal MyotomyCricopharyngeal MyotomyCricopharyngeal myotomy is a surgical sectioning of the cricopharyngeus muscle, also known as the upper esophageal sphincter, that has been advocated for the treatment of cricopharyngeal spasm, or cricopharyngeal achalasia, that leads to cervical dysphagia in the clinical setting....
- Zenker's Diverticulectomy
- Percutaneous endoscopic gastrostomyPercutaneous endoscopic gastrostomyPercutaneous endoscopic gastrostomy is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and...
- Feeding tubeFeeding tubeA feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding...