13 ENT > Dysphagia > Flashcards

Dysphagia Flashcards

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1
Q

any disruption in the swallowing process which results to either physiological or anatomical changes in the mouth, pharynx, larynx, or esophagus

A

dysphagia (solids/liquids/both)

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2
Q

t/f dysphagia is often a symptom of a medical problem

A

true

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3
Q

patients more likely to develop dysphagia

A
  • > 65 yo
  • dementia
  • institutionalized elderly
  • radiotherapy for head and neck cancer
  • stroke
  • learning disabilities
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4
Q

what is neurogenic dysphagia

A
  • neurological disorder that can induce weakness of specific muscles and muscle groups
  • diminished laryngeal closure = silent aspiration
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5
Q

one of the neurogenic causes of dysphagia

A

stroke (ischemic or hemorrhagic)

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6
Q

average duration of swallowing rehab for patients who are dependent on tube feeding

A

two months, only 55% return to an oral diet

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7
Q

in anatomical dysphagia, the severity depends on the ___

A

location of the tumor and extent of the surgery

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8
Q

t/f dysphagia will be negatively influenced by postoperative radiation due to fibrotic changes

A

true, radiation = reduced sensitivity

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9
Q

effective management for anatomical dysphagia

A

swallowing rehabilitation

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10
Q

dysphagia in healthy older adults due to normal aging process

A

presbyphagia

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11
Q

age-related changes in presbyphagia

A
  • difficulty in forming and propelling a bolus
  • a decrease in the pressure of the tongue
  • obstruction of the passage of the bolus
  • stoppage of the bolus when swallowing
  • a decrease in the sensation of smell and taste
  • loss of teeth
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12
Q

management for prebysphagia

A
  • meal texture modification
  • compensatory postures
  • food administraton techniques
  • direct therapeutic procedures
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13
Q

what is sarcopenic dysphagia

A
  • sarcopenia of masticatory muscles and other groups of skeletal musculature
  • loss of muscle mass and strength of the swallowing muscle
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14
Q

sarcopenic dysphagia is higher among

A
  • elderly patients
  • malnourished
  • disuse of swallowing musculature
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15
Q

s/sx of dysphagia

A

read

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16
Q

complications of dysphagia

A
  • weight loss, dehydration, malnutrition
  • reduced quality of life, depression, respiratory problems
  • immunocompromised
  • increased risk of infection
  • poor wound healing
  • decreased functional status
  • muscle breakdown
  • worsening of swallowing activity
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17
Q

most serious problem of patients with dysphagia

A

aspiration pneumonia

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18
Q

symptoms of structural dysphagia

A
  • regular
  • short duration, rapid progression
  • solid, may progress to liquid
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19
Q

history of structural dysphagia

A

alarm features

  • onset >50 yo
  • bleeding
  • odynophagia
  • weight loss
  • vomiting
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20
Q

symptoms of motility dysphagia

A
  • intermittent
  • long duration
  • solid and liquid
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21
Q

history of motility dysphagia

A
  • connective tissue diseases
  • dm
  • non-cardiac chest
  • pain
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22
Q

what is the 3 oz swallow test

A

tests voice hoarseness

  • patient is asked to drink 90 ml water
  • positive: patient coughs during or after swallowing or develop a wet or hoarse voice
  • vocal cord is coated with saliva
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23
Q

what is the gugging swallowing screen test

A
  • graded assessment that considers pathophysiology of voluntary swallowing
  • uses multiple consistencies
  • important for pts with acute stroke related dysphagia
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24
Q

purpose of gugging swallowing screen test

A
  • assess severity of aspiration risk
  • determine recommendation for dietary revisions when necessary
  • can detect slight signs of aspirations
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25
parts of guss test
preliminary assessment (indirect swallowing) direct swallowing test - semisolid: pudding - liquid: thin liquids of 3, 5, 10, 20 ml - solid: dry bread 5x every 10s
26
point system of guss test
- max 5 points per subtest, maximum must be obtained to continue to the next subtest - highest score: 20 pts - <10 = severe dysphagia with high risk of aspiration
27
recommendations from guss test
<5 in subtest: stop exam, special oral diet and further investigation <10: severe dysphagia with high risk for aspiration, npo + further assessment (fees/vfes) + rehab for speech and language
28
bedside test for clinical screening of impaired safety and efficacy of swallowing
volume viscosity swallow test
29
procedure for volume viscosity swallow test
- clinical swallowing examination after stroke is performed with different consistencies and volumes of food - 5-20 ml nectar liquid and then pooling boluses are administered during the video fluoroscopy
30
signs of impaired safety from volume viscosity swallow test
- cough - fall in oxygen saturation of more/= 3% - voice changes
31
signs of impaired efficacy
- piecemeal deglutition | - oropharyngeal residue
32
what is swallowing endoscopy
fiberoptic endoscopic esophageal swallowing test
33
purpose of fees
- to determine and visually see any structural change that can contribute to dysphagia - to assess how well a patient swallows
34
procedure for fees
- the ent passes a thin, flexible instrument through nose - offer food to pt to swallow - view the throat while swallowing different consistencies
35
what is videofluoroscopy / videoendoscopy
- allows assessment of upper airway during swallowing attempts - gives useful information on true feeding dependence - also shows aspiration
36
if the patient has difficulty initiating swallowing, including coughing, choking, and nasal regurgitation, they have __
oropharyngeal dysphagia
37
if the patient has food stopping or sticking after they swallow, they have ___
esophageal dysphagia
38
esophageal dysphagia for solid food or solid/liquid food
solid food only: mechanical obstruction solid or liquid food: neuromuscular disorder
39
intermittent mechanical obstruction vs progressive mechanical obstruction
intermittent for bread/steak: les problem progressive, chronic heartburn, no weightloss: peptic stricture progressive, >50 yo, weight loss: carcinoma
40
intermittent vs progressive neuromuscular disorder
intermittent with chest pain: diffuse esophageal spasm progressive, chronic heartburn: scleroderma progressive, bland regurgitation, weight loss: achalasia
41
evaluation for mechanical and neuromuscular obstruction
esophagoscopy or barium esophagogram neuromuscular disorders: also manometry
42
clues and possible causes of dysphagia
difficulty initiating swallowing, repetitive swallowing: oropharyngeal dysfunction retrosternal "hanging up" sensation: esophageal dysfunction difficulty with solids but not liquids: mechanical obs difficulty with both solids and liquids: esophageal dysmotility regurgitation of undigested food, halitosis: zenker diverticulum
43
treatment considerations
read
44
what is swallowing rehabilitation
- targeted to train tongue muscles to make better bolus in the mouth - improve laryngeal excursion and pharyngeal contraction
45
what is the shaker exercise
- lie flat on back and raise head for 60s, with 60s rest | - do 3-6 times per day for at least 6 wks
46
what is the hyoid lift maneuver
- small pieces of papter - use straw to suck one of the paper - keep sucking and bring to another cup - do until 5-10 pieces are transferred
47
what is the mendelsohn maneuver
- keep adams apple elevated for about 2-5 s each time | - repeat several times per day until you can control swallowing without resistance from hands
48
types of respiratory physiotherapy
- sputum discharge maneuver - huffing - forced expiratory maneuver (breathe + huff) - squeezing (for peripheral lungs)
49
compensatory mechanisms: positioning head and neck
- entrance of respiratory tract narrows - pharyngeal cavity narrows - anterior neck muscles relax - decreases risk for aspiration
50
compensatory mechanisms: breath hold and cough
- learn to hold his breath prior to swallowing and taught to close both true and false vocal folds when swallowing - after swallowing, patient deliberately coughs to clear residue
51
feeding strategies
- sit upright during and 30 mins after meal - head tilted forward/ chin down - support impaired side of body - sit at or below patient's eye level - put food in stronger side - sit on side to maximize careful feeding
52
types of texture modified diets
mild: soft and easily chewed, liquids in syrup consistency moderate: thick puree to finely mashed, liquids in honey texture severe dysphagia: thin puree, liquids that are jelly in consistency
53
high risk foods
- dry stringy meats - mixed textures (soups with bits) - hard foods (boiled sweets) - fibrous foods (coarse vegetables and stalks)
54
diet level 1: puree
- i: severe dysphagia - thick and smooth semiliquid food - non irritating and low in fiber - all thin liquids are omitted or thickened
55
diet level 2: mechanically altered
- i: moderate dysphagia - can tolerate minimally easily chewed foods or cannot swallow thin liquids safely - thickened liquids with commercial thickeners - transition food
56
diet level 3: dysphagia advanced
- i: difficulty chewing, manipulating or swallowing foods - meats are soft and bite sized pieces - regular liquids can be tolerated
57
what is small frequent feeding
6-8 times per day, beneficial for pts with neuromuscular disorders
58
how can nutritional content be improved
table 4
59
populations that would benefit from oral nutrition supplementation
- pts with bmi <20 - weight losing individuals with bmi >/= 20 - patient able to tolerate liquids but not solids
60
indications for enteral feeding
- unsafe to take oral diet - pt is unable to meet nutrient needs from oral diet - malnourished pts with dysphagia - malnourished pts on oral supplements but unable to maintain nutritional status - non malnourished patients with failed textured diet
61
if enteral feeding is >1 mo, needs __
percutaneous gastrotomy
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