Lecture 8: Introduction to Dysphagia

Question 1

How does dysphagia occur?

Answer 1

It’s a symptom of an underlying disease.

Question 2

What are the clinical characteristics of dysphagia?

Answer 2

Difficulty

• Sucking
• Primarily with pediatric populations
• Chewing food
• Swallowing liquids or solids
• Coughing or choking when eating
• Food sticking in the throat or chest

Also:

• Inability to recognize food
• Difficulty placing food in mouth
• Inability to control food or saliva in the mouth
• Coughing/choking before, during, or after a swallow
• Frequent coughing toward the end or immediately after a meal
• Recurring pneumonia or upper respiratory infections
• Fever within an hour after eating
• Unintentional weight loss with no known reason
• Gurgly voice quality

Question 3

What are the definitions for aspiration, penetration, premature spillage, and residue?

Answer 3

• Aspiration
  
  • Material passes BELOW the vocal folds into the trachea
• Penetration
  
  • Material enters the laryngeal vestibule, but remains ABOVE the vocal folds
• Premature spillage
  
  • Material entering the pharynx BEFORE the swallow
• Residue
  
  • Material remaining in the oral cavity, pharynx, or esophagus AFTER a swallow

Question 4

What is the difference between non-instrumental and instrumental swallowing assessments?

Answer 4

Non-instrumental

• Swallow screening
• Clinical swallow evaluation (bedside)
  
  • No dysphagia complaints
  • Patient too medically fragile
  • No swallow elicited in clinical eval
  • Patient not alert
  • Patient uncooperative
  • Results will not alter clinical recommendations

Instrumental

• Videofluoroscopic swallow study (VFSS)
• Fiberoptic endoscopic evaluation of swallowing (FEES)
  
  • Unable to thoroughly address clinical questions
  • Dysphagia characteristics are vague
  • Nutritional or respiratory issues indicate suspicion of dysphagia
  • Safety or efficiency of swallow is a concern
  • Direction for rehabilitation is needed
  • Require assistance determining underlying problem

Question 5

What are the benefits and limitations for the videofluoroscopic swallow study (VFSS) and the fiberoptic endoscopic evaluation of swallow (FEES)? What are the basic procedure of these evaluations and why you might use them?

Answer 5

VFSS

• Limitations
  
  • Radiation exposure
  • Baruim
  • Sometimes view is limited/poor
  • Limited study/conditions (because of radiation exposure and radiology time)
  • Cannot see how patient is handling secretions

FEES

• Limitations
  
  • Cannot view oral stage
  • “White out”: During the moment of a swallow, the tongue and pharynx approximate
  • Penetration/aspiration during the swallow cannot be seen
  • Cannot assess PES
  • Cannot view esophageal phase