HC 6 Medical treatment & team approach Flashcards
What do medical therapies rely on?
On the etiology of the dysphagia (treat the underlying medical condition)
- neuromuscular disease
- GER (gastroesophageal reflux)
- xerostomia
What’s the medical therapy for a person with neuromuscular disease?
- Determine any medication that may contribute to dysphagia, as many drugs affect the cholinergic nervous system (e.g. production of saliva)
- ask list of prescribed medications
=> find a blance between therapeutic benefit and side effects of the medication
Which patient populations are more at risk to GER contributing to swallowing difficulties?
- asthma,
- cricopharyngeal bar on DSS
- glottic incompetence (risk for aspiration)
Which treatment do we provide to patients with GER?
- behavior modifications
- if behavior modification is not adequate to control reflux symptoms: add specific medication
Which anti-reflux recommendations do we give?
- At least 3 to 4 hours before supine position (bed time): no eating
- No bedtime snacks
- Sit upright and use gravity to minimize risk
- Elevate head of the bed by 10-15 cm (blocks are more effective than pillows)
- Antacid medication before going to bed
- Avoid certain foods -> increase gastric acid, lower resting tone, dehydratation (Coffee, tea, pepermint, chocolate, citrus fruits, alcohol)
- Avoid tobacco
What medication may help with GER?
- H2-blockers = standard therapy: specific dose and schedule
- proton-pump inhibitors (2-3 months) = more powerful to decreasing gastric acid production but increased risk of side effects
- symptoms controlled -> replace proton-pump inhibitors by H2-blockers -> can be used long term
What’s the consequence of xerostomia?
Problems with
−Bolus lubrication
−Bolus flow. Poor flow => bolus residue (tongue, palate, pharyngeal wall), risk for aspiration
−Oral mucosal health
−Dental health
−Esophageal GER defense
−Increased viscosity => bolus residue => at risk for aspiration of obstructive bolus
Which factors predispose patients to xerostomia?
- autoimmune conditions
- radiation effects
- medication (dry mucosa, decrease saliva)
- iron or vit. B12 deficiency
How will we treat xerostomia?
−Maximizing general hydration
−Limiting mouth-breathing
−Minimizing products that would contribute to xerostomia (certain medications, mouthwashes or toothpaste with alcohol)
−Minimizing products that favor increased oral bacterial growth
−Maximizing oral hygiene: artificial saliva, pilocarpine
−Avoid potentially irritating foods because of oral sensitivity
−Wet the bolus during oral preparation
When would we consider surgical therapy?
- when structural or anatomic abnormalities results in incompetence
- occasionally when muscular weakness is the etiology
How would surgery benefit lips and oral muscles?
- release contractures that prevent oral closure
- recreate an intact orbicularis oris muscle
How would surgery benefit the soft palate?
- soft palate tissue defects and soft palate muscular weakness may be surgically repaired with local flaps (pharyngeal flap)
- palatal obturators
How would surgery benefit the tongue?
- reconstruction after a floor of the mouth cancer resection to minimize tethering and improve tongue mobility
- when loss of tongue bulk: tissue flaps or fill with body fat
How would surgery beneft the vocal folds?
- vocal fold medialization to correct de vocal fold paralyses -> not always successful in eliminating aspiration
How would surgery benefit the UES opening?
1) relaxation of cricopharyngeus:
- CP myotomy: incisision or cut CP muscle (only if driving forces are still good enough!)
- CP dilatation = enlarged pharynx at rest (catheter with inflatable balloon and stretch muscle -> greater opening)
- botox injection in UES sphincter
2) elevation hyoid & larynx:
- further research needed
