Medication
The key to successful dysphagia rehabilitation is to address the underlying impairments that are causing the dysfunctions. In an effort to target the impairment of stiffness with HNC patients, myofascial release and manual therapy have become increasingly used components of swallowing treatment.
Procedures
This article has been cited by other articles in PMC. Objective: Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies.
Therapy
Previous studies have suggested that the prevalence of dysphagia ranges somewhere between 5% and 22% (9, 31-34), although the majority of these studies only assessed dysphagia in older persons (over age 50 years).
Nutrition
•MBS or VFSS is typically exam of choice given significant oral stage dysphagia and disturbance to all three stages •Patient tremor may be a barrier to FEES •FEES, however:
What is dysphagia and how is it treated?
Are Patient-Reported Outcome Measures appropriate for dysphagia treatment?
What is the prevalence of dysphagia?
What is the best exam for dysphagia?
How many dysphagia are there?
An estimated 9 million Americans suffer from difficulty swallowing, otherwise known as “dysphagia.” Dysphagia becomes more prevalent with age, affecting up to 1 in 5 older adults, and up to 40 percent in institutionalized settings such as nursing homes and assisted-living facilities.
How common is dysphagia?
Dysphagia is a common condition; it affects approximately 13.5% of the general population but is more common in seniors. As more people live to older ages, the incidence of dysphagia is increasing. It affects 19-33% of individuals older than 80 years-of-age, and up to 50% of individuals living in a nursing home.
What is the treatment of dysphagia?
Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids. Trying foods with different textures to see if some cause you more trouble.
What are the 4 stages of dysphagia?
There are 4 phases of swallowing:The Pre-oral Phase. – Starts with the anticipation of food being introduced into the mouth – Salivation is triggered by the sight and smell of food (as well as hunger)The Oral Phase. ... The Pharyngeal Phase. ... The Oesophageal Phase.
What are the 2 types of dysphagia?
Dysphagia has two main types: structural dysphagia, which results from changes to the actual structure of your esophagus, or dysphagia caused by esophageal motility (movement) issues. In some cases, dysphagia results from certain changes to the physical structure of the esophagus.
How is dysphagia treated in the elderly?
Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials.
Can you recover from dysphagia?
Studies show that most individuals with dysphagia recover within two weeks. However, every stroke is different and therefore every recovery will be different. Sometimes dysphagia goes away on its own, a phenomenon called spontaneous recovery. Chances of spontaneous recovery are higher if your stroke was mild.
How many stages of swallowing are there?
three phasesAnatomically, swallowing has been divided into three phases: oral, pharyngeal, and esophageal. The oral phase includes preparatory as well as early transfer phases.
What is the goal for dysphagia?
The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers.
How is oral dysphagia treated?
Treatment for dysphagia Swallowing therapy — this will be done with a speech and language therapist. The individual will learn new ways of swallowing properly. Exercises will help improve the muscles and how they respond. Diet — Some foods and liquids, or combinations of them, are easier to swallow.
How is dysphagia diagnosed?
A videofluoroscopy assesses your swallowing ability. It takes place in the X-ray department and provides a moving image of your swallowing in real time. You'll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.
How fast does dysphagia progress?
Benign strictures typically progress slowly (over a period of months to years) and are associated with minimal weight loss. Malignant esophageal strictures usually cause rapidly progressing dysphagia (over a period of weeks to months) with substantial weight loss. 5.
How common is dysphagia in the elderly?
However, available data (7-11) suggest that dysphagia is surprisingly common, occurring in 8% to 22% of persons over age 50 years. Other studies (12, 13) in nursing homes estimate the prevalence of dysphagia may be as high as 60%. In a gastrointestinal symptom survey study of all ages in a Midwestern population, the prevalence of dysphagia was estimated to be 7% (14) but risk factors for dysphagia were not assessed. Thus, the purpose of this study was to estimate the population prevalence of dysphagia and to identify the characteristics associated with this important alarm symptom.
What medications are used in the frequent and infrequent dysphagia group?
Notably, medications that were assessed (proton pump inhibitors [PPI], calcium channel blockers, antidepressants, antispasmodics, or narcotic pain medication) were more commonly taken by the frequent or infrequent dysphagia group, compared to the no dysphagia group.
What is the sensation of food being hindered during the passage from the mouth through the esophagus?
Dysphagia is the sensation of food being hindered during the passage from the mouth through the esophagus into the stomach (1), and is considered a serious red flag or alarm symptom (2, 3). There are many causes of dysphagia classified into oropharyngeal or esophageal etiologies (4-6). Oropharyngeal dysphagia may arise from neurologic diseases including stroke, Parkinson’s disease, or amyotrophic lateral sclerosis, or a Zenker’s diverticula (4). Causes of esophageal dysphagia (5) include esophageal dysmotility (e.g. achalasia, diffuse esophageal spasm, nutcracker esophagus, or scleroderma), inflammation (e.g. eosinophilic esophagitis, radiation esophagitis), and structural abnormalities (e.g. malignancy, peptic strictures, esophageal rings, or external compression).
Is dysphagia a symptom?
Dysphagia is considered an alarm symptom but detailed population-based data on dysphagia are lacking. We aimed to estimate in a representative US Caucasian population the prevalence of dysphagia and potential risk factors.
Is dysphagia rare in women?
Frequent dysphagia is not rare in the community (3%), occurs in both women and men across all adult age groups, and is most likely to indicate underlying GERD.
How to diagnose dysphagia?
The first and most important step in evaluating dysphagia remains a careful history. Patients will report a sensation that food or drink sticks, holds up or stops, but uncommonly can have other presenting complaints such as regurgitation, vomiting or retrosternal discomfort. The three core aims on history are to establish firstly the presence of true dysphagia, secondly to determine whether the site of the problem is pharyngeal or oesophageal, and finally to determine if there is a structural or motility problem. 7 Reports of ‘difficulty swallowing’ may not necessarily reflect true dysphagia. Globus is the feeling of a lump or foreign body in the throat. A distinction from dysphagia is that globus is present between meals and is unrelated to swallowing, so much so that the symptom often disappears entirely during meals. 7 Xerostomia (oral dryness) can give rise to a sense of dysphagia, although in more severe cases true dysphagia can develop consequent to the loss of the lubricating qualities of saliva leading to delayed bolus transit. Finally, odynophagia, or painful swallowing, most commonly reflects an inflammatory process of the oesophageal mucosa, and is generally transient, lasting only during the time taken for a bolus to traverse the oesophagus. 7
What are the three tests for dysphagia?
The three main investigations for dysphagia are barium oesophagography (barium swallow), upper gastrointestinal endoscopy (gastroscopy) and oesophageal manometry. The choice of which test (s) to undertake and in which order depends on the suspected problem. Apart from the tests outlined below, either an empiric trial of acid suppression or a diagnostic workup for reflux including pH monitoring and impedance testing (outside the scope of this article), may be appropriate in the right clinical context, given the association between reflux and dysphagia, 12 as well as the decreased oesophageal peristaltic vigour with reflux that has been reported to be reversible with proton-pump inhibition. 13
What tests are used to diagnose dysphagia?
A detailed history is the first step in evaluating dysphagia and will form a guide to prioritising subsequent investigation with the three core tests of upper endoscopy, barium swallow and HRM. Upp er endoscopy is the initial, and generally mandated test in suspected oesophageal dysphagia, and is particularly important to exclude malignant obstructive pathologies and to obtain tissue biopsies for the diagnosis of the increasingly prevalent eosinophilic oesophagitis. Barium swallow is useful in the setting of oropharyngeal dysphagia or proximal oesophageal pathology. For assessment of dysmotility, HRM in conjunction with colour-contour topography is the current gold standard and allows for diagnosis based on the Chicago classification. Management of dysphagia largely depends on the underlying pathology, which can include dietary, pharmacologic, endoscopic, and less commonly, surgical approaches.
What is the importance of physical examination for oesophageal dysphagia?
In contrast, the physical examination is generally non-contributory in oesophageal dysphagia; however, it is important to examine the skin and joints for features of connective tissue disorders such as systemic sclerosis , given the association of these conditions with oesophageal hypomotility. The oral cavity should be inspected for dentition, evidence of xerostomia and of infective conditions such as candidiasis. Noting major chest and spine deformities may provide clues for underlying syndromes. Complications of dysphagia such as malnutrition, weight loss and pulmonary complications may also be evident on physical examination.
What causes oesophageal dysphagia?
Causes of oesophageal dysphagia can be broadly categorised into structural problems and motility disorders (Table 2 ). Dysphagia to solids only is suggestive of a mechanical obstruction, whereas motility disorders tend to cause problems with both solid and liquid boluses (although solids are generally affected more). The time-course of dysphagia is helpful for structural causes, with slowly progressive symptoms being a feature of benign pathologies such as a peptic stricture, whereas malignant pathology such as oesophageal carcinoma tends to present more rapidly, often with associated weight loss. Intermittent dysphagia with generally normal function is a feature of eosinophilic oesophagitis, spasm and minor oesophageal mucosal strictures. Given that GORD is the most common disease associated with dysphagia, 12 eliciting typical reflux symptoms such as heartburn and/or regurgitation is helpful. The presence of atopy is a useful clue, as there is a strong association between eosinophilic oesophagitis and atopic diseases such as asthma, food allergy, eczema and chronic rhinitis. 5 Certain oesophageal conditions, for example, achalasia and spasm, can also manifest as chest pain independent of swallowing, and should be considered in the right clinical context. Finally, it is important to note on history-taking risk factors for oesophageal cancer, namely, smoking, alcohol use and longstanding reflux.
What is the most common cause of dysphagia?
In an Australian population-based study of a random sample of 1000 individuals in Sydney, 16% reported ever having dysphagia, 1 with the commonest causes being reflux (31.6%), Schatzki ring and stricture (4.8%) and eosinophilic oesophagitis (1.8%). 2 Dysphagia not only has the potential to cause severe complications such as malnutrition and risk of aspiration but also carries a significant social and psychological burden on the individual. 3 In the past two decades, there has been an increase in the incidence of eosinophilic oesophagitis and achalasia, in part due to greater recognition of these conditions and the development of more advanced diagnostic techniques. 4, 5 In particular, the incidence of eosinophilic oesophagitis has increased so rapidly that it is now thought to be the most frequent eosinophilic gastrointestinal disorder as well as the second most common cause of chronic oesophagitis and dysphagia after gastroesophageal reflux disease (GORD). 6 In this perspective, we will present a systematic approach to dysphagia, including the selection and interpretation of investigations, as well as an overview of contemporary treatment strategies.
What is a barium swallow?
The standard barium swallow involves ingestion of high-density barium in an upright position for double-contrast views of the oesophagus, followed by discrete swallows of low-density barium in a prone position to evaluate oesophageal motility. 14 It is a non-invasive, inexpensive, widely available test that also allows for the assessment of aspiration risk. A barium swallow can be used as the first investigation particularly when the suspected aetiology is oropharyngeal rather than oesophageal, or if there is concern about patient's fitness for endoscopy or regarding endoscopic intubation of the oesophagus such as in suspected laryngeal malignancy, Zenker's diverticulum or upper oesophageal stricture. Cervical osteophytes and cricopharyngeal bar, although not uncommonly found particularly in the elderly, are rarely the sole pathology causing dysphagia unless obstruction to passage of bolus can be objectively demonstrated. Although particularly useful in cases of suspected oropharyngeal dysphagia, barium swallow can also evaluate for obstructive oesophageal lesions or oesophageal dysmotility.
What is the key to successful dysphagia rehabilitation?
The key to successful dysphagia rehabilitation is to address the underlying impairments that are causing the dysfunctions. In an effort to target the impairment of stiffness with HNC patients, myofascial release and manual therapy have become increasingly used components of swallowing treatment.
What is the best treatment for dysphagia after HNC?
Myofascial release and manual therapy are promising modalities to help restore range of motion in the swallowing mechanism after HNC treatment to allow for more effective dysphagia treatment. While more details are still needed about the most effective protocol and techniques, expected outcomes, and the potential long-term benefits, there is optimism in the dysphagia field that MFR/MT may be the key element that increases the effectiveness of swallowing therapy with this population.
What is fibrosis in swallowing?
The fibrosis results in tethering of swallowing structures such as the hyolaryngeal complex which must elevate, protract and approximate to protect the airway. The fibrosis restricts movement of muscles which results in disuse atrophy. Muscles must move to stay strong and to get strong, and the slow accumulation of fibrotic tissue causes increasing ...
What is fascia in medicine?
Fascia is the connective tissue that surrounds muscles, nerves, and organs, and it tight ens and hardens over time in response to trauma (such as radiation treatment) (Kelly 2008). Manual therapy (MT) involves skilled passive movement of joints and soft tissue to restore range of motion. As shown in the chart linked below, ...
Is myofascial release a treatment for dysphagia?
The Role of Myofascial Release and Manual Therapy in Dysphagia Treatment. While many patients develop dysphagia during or immediately following a medical condition, patients with head and neck cancer (HNC) often develop dysphagia due to late-effect complications months or years after radiation treatment (XRT).
Does swallowing exercise improve HNC?
The authors concluded that swallowing exercise, regardless of the application of NMES, did not make a statistically significant improvement in functioning with HNC patients. The authors write “For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are ...
How to treat dysphagia?
The most common dysphagia treatments are listed below. Exercises can strengthen the muscles in the throat and chest involved with swallowing. A speech pathologist or other experienced medical professional may be able to teach these exercises. Swallowing techniques, ranging ...
What is the procedure that expands the esophagus?
Esophageal dilation, a medical procedure that expands the esophagus, can create more space for food to be swallowed.
What is the best way to swallow?
Swallowing techniques, ranging from positioning the head and neck correctly to specific ways to place food in the mouth, can be helpful for people with musculoskeletal issues. Researchers have found the “lean forward method” and the “pop-bottle method” to help many people. 1.
Can swallowing pills cause dysphagia?
Trouble Swallowing Pills (Dysphagia) Relieving Pain When Swallowing Pills Is Difficult. Potential Causes for Dysphagia. Treatments for Dysphagia. In severe cases, treatment may not be possible or successful, and in these cases the person may need to adjust to a liquid diet or use a feeding tube.