lec 8: tx 2

Question 1

surgical tx for cervical osteophytes (1)? what are the approaches (3)?

Answer 1

• osteophytectomy
• anterolateral extra-pharyngeal approach
• posterior extra-pharyngeal approach (least impact on swallowing)
• transoral approach

Question 2

potential complications of osteophytectomy? (4)

Answer 2

1. RLN paralysis
2. fistula
3. hematoma
4. infection

Question 3

stricture surgical tx options (3)?

Answer 3

1. balloon dilation
2. botox
3. cricopharyngeal myotomy to weaken CP muscle (open approach vs endoscopic approach)

Question 4

possible complications (3) vs risk (1) of stricture tx?

Answer 4

• complications: RLN paralysis, hematoma, infection
• risk: aspirating gastric contents esp if airway protection is poor

Question 5

what is a CP bar? (2)

Answer 5

• impingement of posterior UES lumen
• can obstruct bolus flow

Question 6

CP bar surgical tx options (1)? and its’ approaches (2)?

Answer 6

• cricopharyngeal myotomy
• open approach (anterolateral)
• endoscopic approach

Question 7

possible possible complications (3) vs risk (1) of CP bar surgery?

Answer 7

• complications: RLN paralysis, hematoma, infection
• risk: aspirating gastric contents esp if airway protection is poor

Question 8

what is zenker’s diverticulum?

Answer 8

posterior outpouching of CP muscle

Question 9

surgical tx for zenker’s (2)? and their approaches (2)?

Answer 9

• CP myotomy + diverticuletomy
• open approach (anterolateral)
• endoscopic approach

Question 10

possible complications (4) vs risk (1) of ZD surgery?

Answer 10

• complications: RLN paralysis, hematoma, infection, perforation
• risk: aspirating gastric contents esp if airway protection is poor

Question 11

surgical tx for glottic insufficiency following supraglottic laryngectomy? is this considered radical or conservative?

Answer 11

• laryngeal suspension (securing larynx to hyoid or laryngohyoid complex to mandible)
• conservative

Question 12

surgical tx for permanently diverting bolus away from airway? is this considered radical or conservative?

Answer 12

• laryngeotracheal separation (supra, glottic, or sub)
• radical

Question 13

2 types of SUBGLOTTIC laryngeotracheal separation?

Answer 13

1. linderman (tracheoesophageal diversion – trachea connects to esophagus)
2. laryngotracheal separation – they’re just separated

Question 14

what is a laryngectomy? post-op risks (3)?

Answer 14

• complete removal of airway and associated structures
• 1) impaired efficiency, pseudo-epiglottis = residue, fistula = aspiration

Question 15

pharmacological tx associated with…
a) PD
b) MG
c) dystonia

Answer 15

a) sinemet
b) anticholinesterase, plasmapheresis
c) botox

Question 16

peripheral neurostim branches off into… (2)

Answer 16

1. electrical (NMES, PES)
2. non-electrical (air puff, gustatory)

Question 17

what is central neurostim? (2)

Answer 17

• repetitive TMS
• TDCS

Question 18

results of study with antimicrobial gel applied to mouth 4x daily for 2-3 weeks?

a) initial swab
b) AGNB during stay
c) septicemia
d) pneumonia
e) death

Answer 18

• initial swab: control = 4, tx = 7 had bacteria
• during study, bacteria presence increased in both, but less in tx (23 vs 14)
• septicemia was equal (3)
• pneumonia: 7 vs 1
• death: 11 vs 9

Question 19

T or F: biofilm (plaque) forms in mouth every 24 hours if you eat and drink

Answer 19

false – regardless of if you eat or drink

Question 20

if biofilm is aspirated, pt can develop _____.

Answer 20

aspiration pneumonia

Question 21

what removes more bacteria: toothbrush or swab/sponge?

Answer 21

toothbrush!

Question 22

what does oral care reduce (3) vs increase (3)?

Answer 22

• reduces: unfav oral bacteria, risk of asp pneumonia, ventilator associated pneumonia
• increases: desire to eat, awareness of food, ability to swallow

Question 23

in Carnaby et al, what is the diff bw Groups A, B, C?

Answer 23

• A = usual care
• B = low intensity swallow tx (comp strategies only)
• C = high intensity swallow tx (behavioural tx)

Question 24

Carnaby et al results?

Answer 24

• groups B and C had sig % functional swallowing and decrease of dysphagia-related med complications
• group C had trend for improved recovery of swallow function and less chest infection

Question 25

what are the 3 groups in the PROACTIVE study?

Answer 25

- reactive = did not see SLP until issue - pro-active "eat" = taught about diet mod and comp strategies - pro-active "eat + exercise" = taught active exercises as well

Question 26

findings from mapping review of MBSImp components to targeted tx (2)? most studied exercises (2)? most prominent dx (1)?

Answer 26

- most notably laryngeal elevation and anterior hyoid movement - shaker, NMES - stroke

Question 27

what was the adherence % in krekler et al (2018)?

Answer 27

~51

Question 28

adherence facilitators? (6)

Answer 28

1. written instructions 2. social support 3. internal motivation 4. reg supervision and guidance 5. feedback during successful performance 6. relationship w therapist

Question 29

adherence barriers? (5)

Answer 29

1. fatigue 2. pain 3. denial 4. task difficulty 5. memory

Question 30

Is there evidence for therapeutic benefit?

Answer 30

yes, but it is still in its infancy