Oropharyngeal dysphagia

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Oropharyngeal dysphagia arises from abnormalities of the muscles, nerves or oral structures of the mouth, pharynx, and upper esophageal sphincter.

Swallowing disorders can occur in all age groups, due to congenital anomalies, structural damage, and/or medical conditions. Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly, in stroke patients, and in patients admitted to acute care hospitals or chronic care facilities. Other causes of dysphagia include head and neck cancer and progressive neurological disease such as Parkinson's disease, Dementia, Multiple sclerosis, Multiple system atrophy, or Amyotrophic lateral sclerosis. Dysphagia is a symptom of many different causes, which can usually be caused by a careful history by the treating physician. The evaluation of oropharyngeal dysphagia is performed by a speech-language pathologist or occupational therapist.

Dysphagia is classified by deficit areas such as oral, pharynx, oropharyngeal and oesophageal dysphagia. In some patients, no organic cause for dysphagia can be found, and this patient is defined as having functional dysphagia.

Video Oropharyngeal dysphagia

Signs and symptoms

Some signs and symptoms of difficulty swallowing include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating swallowing, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly sound or wet after swallowing, regurgitation nose, and dysphagia (complaints of difficulty swallowing patients). When asked where the food is getting trapped the patient will often point to the cervical area (the neck) as the site of obstruction. The site of obstruction is actually always at or below the level at which the level of obstruction is felt.

Complications

If left untreated, swallowing disorders can potentially lead to aspiration pneumonia, malnutrition, or dehydration.

Maps Oropharyngeal dysphagia

Differential diagnosis

• Stroke can cause high-aspiration pharyngeal dysfunction. The normal swallowing function may or may not return fully after the acute phase lasts about 6 weeks.
• Parkinson's disease can cause "many prepharyngeal, faring, and esophageal disorders". The severity of the disease is most often correlated with the severity of the swallowing disorder.
• Neurological disorders such as stroke, Parkinson's disease, amyotrophic lateral sclerosis, Bell's palsy, or myasthenia gravis can cause facial and lumbar muscle weakness involved in coordinated mastication as well as other important muscle weaknesses from mastication and swallowing./li> Oculopharyngeal muscular dystrophy is a genetic disease with palpebral ptosis, oropharyngeal dysphagia, and proximal limb weakness.
• Decreased salivary flow, which can cause dry mouth or xerostomia, can be caused by certain Sjogren, anticholinergic, antihistamine or antihypertensive syndromes and may result in incomplete food bolus processing.
• Xerostomia can reduce volume and increase the viscosity of oral secretions making bolus formation difficult and reducing the ability to start and swallow bolus
• Dental problems can cause inadequate mastication.
• Abnormalities in the oral mucosa such as from mucositis, aphthous ulcers, or herpes lesions may interfere with the bolus process.
• Mechanical obstruction in the oropharynx may be caused by malignancy, cervical ring or tissue, crico-phyringeus muscle dysfunction, or cervical osteophytes.
Increased upper esophageal sphincter tone may be caused by Parkinson's disease leading to an unresolved UES opening. This can lead to the formation of a Zenker diverticulum.
• The pharyngeal bag usually causes difficulty swallowing after first mouth food, with bag regurgitation. These sacs can be accompanied by foul-smelling breath from the rotting food in the bag. (See Zenker diverticulum)
• Dysphagia is often a side effect of surgical procedures such as anterior cervical spine surgery, carotid endarterectomy, head and neck resection, mouth surgery such as tongue removal, and partial laryngectomy
• Radiotherapy, used to treat head and neck cancers, can cause tissue fibrosis in irradiated areas. Fibrosis of the tongue and larynx leads to reduced base retraction of the tongue and elevation of the larynx during swallowing
• Infection can cause pharyngitis that can prevent swallowing due to pain.
• Drugs can cause central nervous system effects that can cause swallowing disorders and oropharyngeal dysphagia. Examples: sedatives, hypnotic agents, anticonvulsants, antihistamines, neuroleptics, barbiturates, and antiseizure medications. Drugs can also cause peripheral nervous system effects that result in oropharyngeal dysphagia. Examples: corticosteroids, L-tryptophan, and anticholinergics

Adult ratings

Swallowing assessment is usually done for dysphagia. During this initial examination medical history is obtained, mini mental state examinations are sometimes given, and oral and facial, speech, and swallow sensor functions are evaluated non-instrumental.

A patient requiring further investigation will most likely receive a Modified Barium swallow (MBS). The different consistency of liquid and food mixed with barium sulfate is fed to patients with spoons, cups or syringes, and x-rayed using videofluoroscopy. The patient's swallow can then be evaluated and explained. Some doctors may choose to describe each phase of swallowing in detail, stating the delay or deviation from the norm. Others may choose to use rank scale such as Penetration Aspiration Scale. This scale was developed to illustrate the physiology of disorders from ingesting a person using numbers 1-8. Other scales also exist for this purpose.

A patient can also be assessed using videoendoscopy, also known as a flexible fiberoptic swallow endoscopy (FFEES). The instrument is placed into the nose until the doctor can see the pharynx and then he checks the pharynx and larynx before and after swallowing. During the actual swallow, the camera is blocked from seeing an anatomical structure. Rigid coverage, placed into the oral cavity to see the pharyngeal and laryngeal structures, can also be used, although this prevents the patient from ingesting.

Other rare swallowing assessments are imaging studies, ultrasound and scintigraphy and nonimaging studies, electromyography (EMG), electroglottography (EGG) (record vocal cord movement), cervical auscultation, and pharyngeal manometry.

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Treatment

After the assessment, to determine the safety of ingesting a person and recommending appropriate treatment.

Postural technique.

The back head (extension) - used when the bolus movement from the front of the mouth to the back is inefficient; this allows gravity to help move food.

The chin down (flexion) - used when there is a delay in starting the swallow; this allows the valleculae to widen, the airways narrow, and the epiglottis is pushed into the back of the throat to better protect the airway from food.

The chin down (flexion) - used when the back of the tongue is too weak to push food into the pharynx; this causes the back of the tongue closer to the pharyngeal wall.

The rotation of the head (turning head to shoulder) to the damaged or weak side with the chin - used when the airway is not adequately protected causes the food to be sucked; this causes the epiglottis to be placed in a more protective position, narrowing the airway entrance, and improving vocal cord closure.

Lying on one side - used when there is a decrease in pharyngeal contraction causes excess residue in the pharynx; this eliminates the gravitational pull that can cause residues to be sucked when the patient breathes again.

Head rotation to the damaged or weaker side - used when there is paralysis or paresis on one side of the pharyngeal wall; this causes the bolus to descend to the stronger side.

Head tilted (ear to shoulder) to the stronger side - used when there is weakness on one side of the oral cavity and the pharyngeal wall; this causes the bolus to descend to the stronger side.

Swallowing Maneuvers.

• Supraglottic swallow - The patient is asked to take a deep breath and hold their breath. While holding their breath will swallow and then immediately cough after swallowing. This technique can be used when there is a closing of late or delayed vocal folds or a delayed pharyngeal egg.
• Super-supraglottic swallow - The patient is asked to take a breath, hold his breath tightly while lowering, swallowing while holding his breath, and then coughing immediately after swallowing. This technique can be used when there is a reduction in airway closure.
• Swallowing - Patients are instructed to squeeze their muscles strongly while swallowing. It can be used when there is a posterior motion down from the base of the tongue.
• Mendelsohn maneuver - Patient is taught how to hold their apple adam during swallowing. This technique can be used when there is a decreased laryngeal movement or a swallow bird that is discoordinative.

Medical devices

To strengthen the muscles in the mouth and throat areas, researchers at the University of Wisconsin-Madison, led by Dr. JoAnne Robbins, developed a tool in which patients do isometric exercise with the tongue.

Dietary modifications

Modified diet can be justified. Some patients require soft-chewing diets, and some require thinning or thickening consistency.

Environmental modifications

Environmental modification can be suggested to help and reduce risk factors for aspiration. For example, remove interruptions like too many people in the room or turn off the TV while breastfeeding, etc.

Oral sensory awareness techniques

Oral sensory awareness techniques can be used with patients who have swallowing apraxia, tactile agnosia for food, slow onset of oral swallowing, reduced oral sensation, or delayed onset of pharyngeal swallowing.

• spoon pressure against the tongue
• using the acid bolus
• using cold bolus
• using bolus that needs to be chewed
• using bolus larger than 3mL
• thermal-tactile (controversial) stimulation

Electrical stimulation

Electrical stimulation (E-stim) is targeted for oropharyngeal dysphagia and uses electrical stimulation to re-train the muscles used in swallowing and facilitate voluntary swallowing. This type of therapy has been used in clinical settings for many years in Physical Therapy. Its use for oropharyngeal dysphagia has gained much attention in recent years and is now the most investigated treatment intervention in dysphagia therapy.

Prosthetic

• Palatal lift or Palatal obturator
• Maximized denture

Surgery

This is usually only recommended as a last resort.

• Tracheostomy
• Tracheostomy
• Multiplier folding/vocal injection
• medianisasi medianisasi
• erytenoid adduction
• Partial or total laringectomy
• Separation of laryngotheat
• Supralaryngectomy
• Palatoplasty
• Cricopharyngeal myotomy
• Zenker Divertikulektomi
• percutaneous endoscopic gastrostomy
• Food tube

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References

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External links

• Swallowing and Feeding

Source of the article : Wikipedia