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13 ENT > Dysphagia > Flashcards

Dysphagia Flashcards

1
Q

any disruption in the swallowing process which results to either physiological or anatomical changes in the mouth, pharynx, larynx, or esophagus

A

dysphagia (solids/liquids/both)

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2
Q

t/f dysphagia is often a symptom of a medical problem

A

true

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3
Q

patients more likely to develop dysphagia

A
  • > 65 yo
  • dementia
  • institutionalized elderly
  • radiotherapy for head and neck cancer
  • stroke
  • learning disabilities
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4
Q

what is neurogenic dysphagia

A
  • neurological disorder that can induce weakness of specific muscles and muscle groups
  • diminished laryngeal closure = silent aspiration
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5
Q

one of the neurogenic causes of dysphagia

A

stroke (ischemic or hemorrhagic)

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6
Q

average duration of swallowing rehab for patients who are dependent on tube feeding

A

two months, only 55% return to an oral diet

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7
Q

in anatomical dysphagia, the severity depends on the ___

A

location of the tumor and extent of the surgery

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8
Q

t/f dysphagia will be negatively influenced by postoperative radiation due to fibrotic changes

A

true, radiation = reduced sensitivity

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9
Q

effective management for anatomical dysphagia

A

swallowing rehabilitation

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10
Q

dysphagia in healthy older adults due to normal aging process

A

presbyphagia

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11
Q

age-related changes in presbyphagia

A
  • difficulty in forming and propelling a bolus
  • a decrease in the pressure of the tongue
  • obstruction of the passage of the bolus
  • stoppage of the bolus when swallowing
  • a decrease in the sensation of smell and taste
  • loss of teeth
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12
Q

management for prebysphagia

A
  • meal texture modification
  • compensatory postures
  • food administraton techniques
  • direct therapeutic procedures
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13
Q

what is sarcopenic dysphagia

A
  • sarcopenia of masticatory muscles and other groups of skeletal musculature
  • loss of muscle mass and strength of the swallowing muscle
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14
Q

sarcopenic dysphagia is higher among

A
  • elderly patients
  • malnourished
  • disuse of swallowing musculature
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15
Q

s/sx of dysphagia

A

read

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16
Q

complications of dysphagia

A
  • weight loss, dehydration, malnutrition
  • reduced quality of life, depression, respiratory problems
  • immunocompromised
  • increased risk of infection
  • poor wound healing
  • decreased functional status
  • muscle breakdown
  • worsening of swallowing activity
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17
Q

most serious problem of patients with dysphagia

A

aspiration pneumonia

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18
Q

symptoms of structural dysphagia

A
  • regular
  • short duration, rapid progression
  • solid, may progress to liquid
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19
Q

history of structural dysphagia

A

alarm features

  • onset >50 yo
  • bleeding
  • odynophagia
  • weight loss
  • vomiting
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20
Q

symptoms of motility dysphagia

A
  • intermittent
  • long duration
  • solid and liquid
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21
Q

history of motility dysphagia

A
  • connective tissue diseases
  • dm
  • non-cardiac chest
  • pain
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22
Q

what is the 3 oz swallow test

A

tests voice hoarseness

  • patient is asked to drink 90 ml water
  • positive: patient coughs during or after swallowing or develop a wet or hoarse voice
  • vocal cord is coated with saliva
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23
Q

what is the gugging swallowing screen test

A
  • graded assessment that considers pathophysiology of voluntary swallowing
  • uses multiple consistencies
  • important for pts with acute stroke related dysphagia
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24
Q

purpose of gugging swallowing screen test

A
  • assess severity of aspiration risk
  • determine recommendation for dietary revisions when necessary
  • can detect slight signs of aspirations
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25
Q

parts of guss test

A

preliminary assessment (indirect swallowing)

direct swallowing test

  • semisolid: pudding
  • liquid: thin liquids of 3, 5, 10, 20 ml
  • solid: dry bread 5x every 10s
26
Q

point system of guss test

A
  • max 5 points per subtest, maximum must be obtained to continue to the next subtest
  • highest score: 20 pts
  • <10 = severe dysphagia with high risk of aspiration
27
Q

recommendations from guss test

A

<5 in subtest: stop exam, special oral diet and further investigation
<10: severe dysphagia with high risk for aspiration, npo + further assessment (fees/vfes) + rehab for speech and language

28
Q

bedside test for clinical screening of impaired safety and efficacy of swallowing

A

volume viscosity swallow test

29
Q

procedure for volume viscosity swallow test

A
  • clinical swallowing examination after stroke is performed with different consistencies and volumes of food
  • 5-20 ml nectar liquid and then pooling boluses are administered during the video fluoroscopy
30
Q

signs of impaired safety from volume viscosity swallow test

A
  • cough
  • fall in oxygen saturation of more/= 3%
  • voice changes
31
Q

signs of impaired efficacy

A
  • piecemeal deglutition

- oropharyngeal residue

32
Q

what is swallowing endoscopy

A

fiberoptic endoscopic esophageal swallowing test

33
Q

purpose of fees

A
  • to determine and visually see any structural change that can contribute to dysphagia
  • to assess how well a patient swallows
34
Q

procedure for fees

A
  • the ent passes a thin, flexible instrument through nose
  • offer food to pt to swallow
  • view the throat while swallowing different consistencies
35
Q

what is videofluoroscopy / videoendoscopy

A
  • allows assessment of upper airway during swallowing attempts
  • gives useful information on true feeding dependence
  • also shows aspiration
36
Q

if the patient has difficulty initiating swallowing, including coughing, choking, and nasal regurgitation, they have __

A

oropharyngeal dysphagia

37
Q

if the patient has food stopping or sticking after they swallow, they have ___

A

esophageal dysphagia

38
Q

esophageal dysphagia for solid food or solid/liquid food

A

solid food only: mechanical obstruction

solid or liquid food: neuromuscular disorder

39
Q

intermittent mechanical obstruction vs progressive mechanical obstruction

A

intermittent for bread/steak: les problem

progressive, chronic heartburn, no weightloss: peptic stricture
progressive, >50 yo, weight loss: carcinoma

40
Q

intermittent vs progressive neuromuscular disorder

A

intermittent with chest pain: diffuse esophageal spasm

progressive, chronic heartburn: scleroderma
progressive, bland regurgitation, weight loss: achalasia

41
Q

evaluation for mechanical and neuromuscular obstruction

A

esophagoscopy or barium esophagogram

neuromuscular disorders: also manometry

42
Q

clues and possible causes of dysphagia

A

difficulty initiating swallowing, repetitive swallowing: oropharyngeal dysfunction

retrosternal “hanging up” sensation: esophageal dysfunction

difficulty with solids but not liquids: mechanical obs

difficulty with both solids and liquids: esophageal dysmotility

regurgitation of undigested food, halitosis: zenker diverticulum

43
Q

treatment considerations

A

read

44
Q

what is swallowing rehabilitation

A
  • targeted to train tongue muscles to make better bolus in the mouth
  • improve laryngeal excursion and pharyngeal contraction
45
Q

what is the shaker exercise

A
  • lie flat on back and raise head for 60s, with 60s rest

- do 3-6 times per day for at least 6 wks

46
Q

what is the hyoid lift maneuver

A
  • small pieces of papter
  • use straw to suck one of the paper
  • keep sucking and bring to another cup
  • do until 5-10 pieces are transferred
47
Q

what is the mendelsohn maneuver

A
  • keep adams apple elevated for about 2-5 s each time

- repeat several times per day until you can control swallowing without resistance from hands

48
Q

types of respiratory physiotherapy

A
  • sputum discharge maneuver
  • huffing
  • forced expiratory maneuver (breathe + huff)
  • squeezing (for peripheral lungs)
49
Q

compensatory mechanisms: positioning head and neck

A
  • entrance of respiratory tract narrows
  • pharyngeal cavity narrows
  • anterior neck muscles relax
  • decreases risk for aspiration
50
Q

compensatory mechanisms: breath hold and cough

A
  • learn to hold his breath prior to swallowing and taught to close both true and false vocal folds when swallowing
  • after swallowing, patient deliberately coughs to clear residue
51
Q

feeding strategies

A
  • sit upright during and 30 mins after meal
  • head tilted forward/ chin down
  • support impaired side of body
  • sit at or below patient’s eye level
  • put food in stronger side
  • sit on side to maximize careful feeding
52
Q

types of texture modified diets

A

mild: soft and easily chewed, liquids in syrup consistency
moderate: thick puree to finely mashed, liquids in honey texture
severe dysphagia: thin puree, liquids that are jelly in consistency

53
Q

high risk foods

A
  • dry stringy meats
  • mixed textures (soups with bits)
  • hard foods (boiled sweets)
  • fibrous foods (coarse vegetables and stalks)
54
Q

diet level 1: puree

A
  • i: severe dysphagia
  • thick and smooth semiliquid food
  • non irritating and low in fiber
  • all thin liquids are omitted or thickened
55
Q

diet level 2: mechanically altered

A
  • i: moderate dysphagia
  • can tolerate minimally easily chewed foods or cannot swallow thin liquids safely
  • thickened liquids with commercial thickeners
  • transition food
56
Q

diet level 3: dysphagia advanced

A
  • i: difficulty chewing, manipulating or swallowing foods
  • meats are soft and bite sized pieces
  • regular liquids can be tolerated
57
Q

what is small frequent feeding

A

6-8 times per day, beneficial for pts with neuromuscular disorders

58
Q

how can nutritional content be improved

A

table 4

59
Q

populations that would benefit from oral nutrition supplementation

A
  • pts with bmi <20
  • weight losing individuals with bmi >/= 20
  • patient able to tolerate liquids but not solids
60
Q

indications for enteral feeding

A
  • unsafe to take oral diet
  • pt is unable to meet nutrient needs from oral diet
  • malnourished pts with dysphagia
  • malnourished pts on oral supplements but unable to maintain nutritional status
  • non malnourished patients with failed textured diet
61
Q

if enteral feeding is >1 mo, needs __

A

percutaneous gastrotomy

13 ENT (18 decks)

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