Swallowing Disorders Chapter 3

* Imaging Studies * Ultrasound * Videoendoscopy * Videofluoroscopy * Scintigraphy

* Observe tongue function * Measures oral transit times * Measures motion of the hyoid bone * No visualization of the pharynx * Limited study

* Also called FEES- Flexible fiberoptic examination of swallowing * Flexible scope inserted into the nose down to level of soft palate or below * Light topical anesthesia in the nose * Views before and after the swallow * Can assess patient’s ability to use airway closure maneuvers * Excellent superior view of pharyngeal anatomy * Can be done at bedside * No radiation exposure

* Does not visualize during the swallow * Difficult to define the exact nature of the patient’s physiologic disorder * Have to make inferences * Does not visualize the oral phase

* Most frequently used- Gold Standard * Can evaluate all phases of the swallow * Can view in slow motion, frame by frame when recorded * Provide information on * Bolus transit times * Motility problems * Etiology of aspiration

* Low dose of radiation exposure * Lateral view * A-P view * All consistencies must be mixed with barium in order to view them * Can trial treatment strategies during the study to look at effectiveness with different liquid and solid consistencies

* Nuclear medicine test * Patient swallows measured amounts of radioactive substance * Amount of aspiration and residue can be measured * Physiology of mouth and pharynx are not visualized * Can be used as a diagnostic for esophageal reflux and esophageal phase of swallow

* Electromyography * Electroglottography * Cervical Auscultation * Pharyngeal Manometry

* Muscles can provide information on the timing and relative amplitude of selected muscle contraction during the swallow * Two electrodes are placed in each muscle to be analyzed- surface or hooked-wire electrodes * Can be used as a biofeedback technique during therapy * Laryngeal elevation * Effortful swallow

* Tracks vocal fold movement by recording the impedance changes as vocal folds open and close * Equipment can also track laryngeal elevation * Determining onset and termination of pharyngeal swallow * Biofeedback on extend and duration of laryngeal elevation during the swallow

* Recording sounds produced during the swallow * Placing a small microphone or using a stethoscope on the surface of the patient’s neck at various locations * “Click” associated with the opening of the eustachian tube * “Clunk” associated with the opening of the Upper Esophageal Sphincter * Not at lot of evidence based research to distinguish normal vs. abnormal sounds

* Listen to respiration and define the following * Inhalatory and exhalatory phases of the respiratory cycle * When the pharyngeal swallow occurs and in which part of the respiratory cycle * Changes in secretion levels before and after the swallow

* Use videofluoroscopy concurrently to define the etiology of pressure changes * Measures intrabolus pressures and the timing of the pharyngeal contractile wave * Pressure sensors are encased in a flexible 3-mm tube and placed transnasally * Sensor is located at the tongue base * Sensor at upper esophageal sphincter * Sensor at cervical esophagus

* Indirect examination of the relaxation of the Upper esophageal sphincter * Not used as a general diagnostic tool due to reduced availability as well as being a relatively invasive technique and requiring significant personnel and equipment