RESPIRATORY AND IATROGENIC CAUSES OF DYSPHAGIA

Question 1

What is an iatrogenic cause?

Answer 1

Damage caused by medical intervention (medication, surgery, some other intervention, etc.)

Question 2

What are the two kinds of artificial airways are created?

Answer 2

Endotracheal Tube – Through the mouth/nose

Tracheostomy Tube – Hole created in the trachea.

Question 3

What do you place in the stoma to keep it open? What parts does it consist of?

Answer 3

Trach Tube:
Outer Canula (Outer tube)
Inner Canula (Inner Tube)

Question 4

When do you have to use a cuff?

Answer 4

When the respiratory needs are higher. When some air is going through the larynx.

Question 5

What is a disadvantage of using a cuff? Is there an alternate?

Answer 5

You can’t use speech.

Using a speaking/passy-muir valve!

Question 6

What is a speaking/passy-muir valve?

Answer 6

A valve that is placed near the stoma that allows for air to go into the larynx but not out, forcing the air to go upwards to the vocal folds, creating a voice.

Question 7

Describe the relationship between a cuff and a Passy-Muir valve.

Answer 7

You MUST deflate the cuff before using the Passy-Muir valve or you will kill the patient. The cuff isolates the airflow to just the stoma location, in and out. The Passy-Muir valve allows for inhalation through the stoma but forces exhalation to occur through the vocal folds and ultimately the mouth/nose for speech. So, you won’t be able to exhale if they are both in use.

Question 8

When a patient has a lot of respiratory needs, what is the ideal progression of cuffs?

Answer 8

You will start by inflating the cuff fully (they won’t be able to speak for a while). Then, begin deflating the cuff, moving towards a more natural pattern involving the larynx.
Then move on to a cuffless stage.

Question 9

What are some swallow risks associated with a tracheostomy?

Answer 9

Increased risk of aspiration due to:
Poor sub-glottic pressure.
Poor laryngeal elevation – disputed.
Reduced upper airway sensitivity
General muscle weakness.

Question 10

What are the two ways an endotracheal tube can be placed?

Answer 10

Through the mouth or through the nose.

Question 11

What are some dysphagia symptoms as a result of surgery?

Answer 11

Damage to nerve endings (peripheral nerves).

Damage to brainstem during skull base surgeries.

Edema (swelling) – temporary.

Surgery for cancers are more invovled and nearby structures are at risk.

Question 12

What is a risk factor associated with a Thyroidectomy?

Answer 12

Thyroidectomy: Removal of thyroid gland could impair Vagus nerve endings leading to VF paralysis.

Question 13

What is a risk factor associated with a Carotid Endarterectomy?

Answer 13

Carotid Endarterectomy: Removal of plaques from arteries could impair vagus nerve (Pharyngeal constrictor action, VF actions impaired).

Question 14

What is a risk factor associated with cervical spine procedures? Anterior cervical fusions?

Answer 14

Cervical Spine Procedures: Impairs CN IX and X. Could also impair brainstem connections to peripheral nerves.

Anterior Cervical fusion: Decompression of Spinal cord/nerve roots.

Question 15

What is a risk factor associated with skull base surgeries?

Answer 15

Skull base surgeries: Impairs brain stem and causes dysphagia.

Question 16

What are some medications associated with dysphagia?

Answer 16

Antipsychotics and Anti-convulsants.

Anti-psychotics and depressants: Tardive dyskinesia (isolated dysarthria of oral cavity.), Xerostomia.

Respiratory and cardiac medications: LES impairment and subsequently GERD.

Cholesterol controllers: Generalized myopathies.

Question 17

What is COPD?

Answer 17

Chronic Obstructive Pulmonary Disease: an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.

Question 18

At what stage of the breathing process do people with COPD tend to swallow?

Answer 18

Patients with COPD are more likely to swallow at times during the breathing cycle when they have low sub-glottic air pressure. Swallow during inhalation or inhalation immediately after a swallow.

Question 19

What is the concern with swallowing during inhalation or inhaling immediately after a swallow such as is seen in patients with COPD?

Answer 19

Residue in the pharynx could be drawn into the airway

ASPIRATION!!!

Question 20

In healthy people, what is the relationship between swallowing and breathing?

Answer 20

Inhale, swallow, exhale.