Podcast
Questions and Answers
Which of the following is NOT a goal of dysphagia management?
Which of the following is NOT a goal of dysphagia management?
Which treatment approach involves surgery?
Which treatment approach involves surgery?
What is the intended effect of Cricopharyngeal Myotomy?
What is the intended effect of Cricopharyngeal Myotomy?
Remove UES outlet obstruction and improve bolus flow.
What is Capsaicin known to improve in dysphagia management?
What is Capsaicin known to improve in dysphagia management?
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Which feeding method is less invasive?
Which feeding method is less invasive?
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Match the behavioral management techniques to their purpose:
Match the behavioral management techniques to their purpose:
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Total Laryngectomy involves removing the larynx to prevent aspiration.
Total Laryngectomy involves removing the larynx to prevent aspiration.
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The _______ is the surgical procedure that injects botox into the UES.
The _______ is the surgical procedure that injects botox into the UES.
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What impact does neurostimulation aim to achieve in dysphagia treatment?
What impact does neurostimulation aim to achieve in dysphagia treatment?
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What is one of the main goals of dysphagia treatment?
What is one of the main goals of dysphagia treatment?
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Which treatment approach is NOT a surgical method for managing dysphagia?
Which treatment approach is NOT a surgical method for managing dysphagia?
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What effect does a cricopharyngeal myotomy have on bolus flow?
What effect does a cricopharyngeal myotomy have on bolus flow?
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Which of the following is a common non-surgical medical management approach?
Which of the following is a common non-surgical medical management approach?
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The technique that increases coordination of swallow physiology through increasing awareness is called ______.
The technique that increases coordination of swallow physiology through increasing awareness is called ______.
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Behavioral management does not involve changing diet consistency.
Behavioral management does not involve changing diet consistency.
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What is the purpose of a total laryngectomy?
What is the purpose of a total laryngectomy?
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What is the primary function of the Mendelsohn Maneuver?
What is the primary function of the Mendelsohn Maneuver?
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Match the following intervention techniques to their functions:
Match the following intervention techniques to their functions:
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Which type of feeding is often used for patients unable to get proper nutrition by mouth?
Which type of feeding is often used for patients unable to get proper nutrition by mouth?
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What is the purpose of a UES Cricopharyngeal Myotomy?
What is the purpose of a UES Cricopharyngeal Myotomy?
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What is the goal of UES botox injection?
What is the goal of UES botox injection?
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What is the intended effect of UES Dilatation?
What is the intended effect of UES Dilatation?
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What is the purpose of Pharyngeal Flap Surgery?
What is the purpose of Pharyngeal Flap Surgery?
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What is a Total Laryngectomy?
What is a Total Laryngectomy?
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What is the purpose of a Tracheostomy?
What is the purpose of a Tracheostomy?
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What is the intended effect of vocal fold medialization?
What is the intended effect of vocal fold medialization?
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Study Notes
Goals of Dysphagia Management
- Ensure pulmonary safety during swallowing
- Achieve adequate nutrition for health and energy
- Maximize the patient's quality of life
- Aim for normal or near-normal swallowing; complete normalization may not be achievable
Treatment Approaches
- Surgical interventions when other therapies fail
- Medical management including pharmacological options
- Behavioral strategies to support swallowing
- Neurostimulation techniques for muscle maintenance
Surgical Management
- Typically employed if non-surgical therapies are ineffective
- Procedures often target the larynx or upper esophageal sphincter (UES)
Surgical Procedures and Their Effects
- Cricopharyngeal Myotomy: Removes UES blockage, enhancing bolus flow
- Botox Injection: Reduces UES obstruction, improving swallowing
- UES Dilatation: Expands size of UES for better bolus passage
- Pharyngeal Flap Surgery: Mitigates velopharyngeal insufficiency
- Total Laryngectomy: Dismantles larynx to prevent aspiration risks
- Tracheostomy: Provides secure airway to diminish aspiration chances
- Vocal Fold Medialization: Improves glottic closure for safer swallowing
Medical Management
-
Pharmacological Treatments:
- Capsaicin: Enhances pharyngeal sensation by promoting substance P release
- Cholinesterase Inhibitors: Improves involuntary muscle function for patients with conditions like Alzheimer’s and Myasthenia Gravis
-
Enteral Feeding:
- Utilized when oral nutrition is impossible or unsafe
- NGT: Quick insertion; lasts about a month; higher discomfort
- PEG: More invasive; designed for long-term usage (up to 9 months); lower discomfort, but carries infection risk
Behavioral Management
- Adjusts diet and patient behaviors to enhance swallowing safety and effectiveness
- Bolus Modification: Alters consistency and texture of food and liquids to reduce aspiration risks
- Compensatory Strategies: Quick, temporary fixes to swallowing difficulties
Compensatory Techniques
- Cued Swallowing: Enhances coordination during swallowing
- Effortful Swallowing: Improves base of tongue retraction
- Mendelsohn Maneuver: Increases laryngeal elevation duration
- Supraglottic Swallow: Enhances vocal fold closure
- Chin Tuck: Advantages coordination and airway protection during swallowing
- Head Turn or Tilt: Assists in directing bolus to stronger sides or narrows weak side for better swallowing
- Reclining Position: Utilizes gravity for bolus transport
Rehabilitation Exercises
- Enhances neuromuscular control, can utilize food for direct application
- OPM Exercises: Strengthens oral-pharyngeal muscles
- Shaker Exercise: Targets anterior neck muscles aiding UES opening
Neurostimulation
- Neuromuscular Electrical Stimulation (NMES): Uses electrical impulses to maintain muscle integrity and prevent atrophy
Intervention Team
- Physician: Oversees overall patient care
- Neurologist: Focuses on brain-related swallowing disorders
- Pulmonologist: Assesses breathing safety and efficiency
- Otorhinolaryngologist: Conducts swallow evaluations with instrumentation support
- Dietician: Designs nutrition plans tailored to patient's needs
- Speech-Language Pathologist: Works on swallowing skill improvement and safe food and fluid consistency recommendations
- Occupational Therapist: Aids in independent feeding practices
- Physical Therapist: Ensures optimal posture for swallowing facilitation
- Pharmacist: Manages medication dosing and interactions
Goals of Dysphagia Management
- Ensure pulmonary safety during swallowing
- Achieve adequate nutrition for health and energy
- Maximize the patient's quality of life
- Aim for normal or near-normal swallowing; complete normalization may not be achievable
Treatment Approaches
- Surgical interventions when other therapies fail
- Medical management including pharmacological options
- Behavioral strategies to support swallowing
- Neurostimulation techniques for muscle maintenance
Surgical Management
- Typically employed if non-surgical therapies are ineffective
- Procedures often target the larynx or upper esophageal sphincter (UES)
Surgical Procedures and Their Effects
- Cricopharyngeal Myotomy: Removes UES blockage, enhancing bolus flow
- Botox Injection: Reduces UES obstruction, improving swallowing
- UES Dilatation: Expands size of UES for better bolus passage
- Pharyngeal Flap Surgery: Mitigates velopharyngeal insufficiency
- Total Laryngectomy: Dismantles larynx to prevent aspiration risks
- Tracheostomy: Provides secure airway to diminish aspiration chances
- Vocal Fold Medialization: Improves glottic closure for safer swallowing
Medical Management
-
Pharmacological Treatments:
- Capsaicin: Enhances pharyngeal sensation by promoting substance P release
- Cholinesterase Inhibitors: Improves involuntary muscle function for patients with conditions like Alzheimer’s and Myasthenia Gravis
-
Enteral Feeding:
- Utilized when oral nutrition is impossible or unsafe
- NGT: Quick insertion; lasts about a month; higher discomfort
- PEG: More invasive; designed for long-term usage (up to 9 months); lower discomfort, but carries infection risk
Behavioral Management
- Adjusts diet and patient behaviors to enhance swallowing safety and effectiveness
- Bolus Modification: Alters consistency and texture of food and liquids to reduce aspiration risks
- Compensatory Strategies: Quick, temporary fixes to swallowing difficulties
Compensatory Techniques
- Cued Swallowing: Enhances coordination during swallowing
- Effortful Swallowing: Improves base of tongue retraction
- Mendelsohn Maneuver: Increases laryngeal elevation duration
- Supraglottic Swallow: Enhances vocal fold closure
- Chin Tuck: Advantages coordination and airway protection during swallowing
- Head Turn or Tilt: Assists in directing bolus to stronger sides or narrows weak side for better swallowing
- Reclining Position: Utilizes gravity for bolus transport
Rehabilitation Exercises
- Enhances neuromuscular control, can utilize food for direct application
- OPM Exercises: Strengthens oral-pharyngeal muscles
- Shaker Exercise: Targets anterior neck muscles aiding UES opening
Neurostimulation
- Neuromuscular Electrical Stimulation (NMES): Uses electrical impulses to maintain muscle integrity and prevent atrophy
Intervention Team
- Physician: Oversees overall patient care
- Neurologist: Focuses on brain-related swallowing disorders
- Pulmonologist: Assesses breathing safety and efficiency
- Otorhinolaryngologist: Conducts swallow evaluations with instrumentation support
- Dietician: Designs nutrition plans tailored to patient's needs
- Speech-Language Pathologist: Works on swallowing skill improvement and safe food and fluid consistency recommendations
- Occupational Therapist: Aids in independent feeding practices
- Physical Therapist: Ensures optimal posture for swallowing facilitation
- Pharmacist: Manages medication dosing and interactions
Surgical Management Overview
- Surgical intervention is considered when therapy fails to yield satisfactory results.
- Most surgeries target the larynx or upper esophageal sphincter (UES).
UES Surgical Procedures
-
Cricopharyngeal Myotomy:
- Involves cutting the cricopharyngeus muscle to remove obstruction at the UES.
- Aims to enhance bolus flow.
-
Botox Injection:
- Botulinum toxin is injected into the UES.
- Effectively alleviates outlet obstruction, improving bolus passage.
-
Dilatation:
- Mechanical widening of the UES to eliminate constriction.
- Facilitates better bolus flow by correcting strictures.
Velopharyngeal Surgery
-
Pharyngeal Flap Surgery:
- Tissue from the pharynx is surgically attached to the soft palate.
- Intent is to reduce velopharyngeal insufficiency, aiding in speech clarity.
Laryngeal Surgical Interventions
-
Total Laryngectomy:
- Complete surgical removal of the larynx.
- Primarily performed to prevent aspiration.
-
Tracheostomy:
- Surgical incision made below the vocal folds with a tube inserted.
- Procedure secures the airway and minimizes the risk of aspiration.
-
Vocal Fold Medialization:
- A surgery aimed at improving glottic closure by repositioning or augmenting the vocal folds.
- Enhances the approximation of vocal folds for better voice quality.
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Description
Explore the various goals and treatment methods for dysphagia, including surgical, medical, and behavioral approaches. Understand how to enhance pulmonary safety and improve the quality of life for individuals with swallowing difficulties. Find out the importance of proper nutrition and potential techniques for rehabilitation.
