The management of swallowing disorders through rehabilitation methods

Abstract

Objectives: Swallowing disorders are commonly encountered in ENT practice, and dysphagia may pre- sent a challenge with respect to diagnosis and man­ agement. This study aimed to examine patients with swallowing disorders.Patients and Methods: The study included 280 patients 153 males, 127 females; mean age 53 years; range 3- 98 years who presented with complaints of swallowing difficulties betvveen October 2000 and June 2002. The patients were examined according to the protocol of our department for swallowing disorders, which involved a detailed history taking, a patient questionnaire on swal- lovving disorders, cervical auscultation, and modified bar- ium swallow studies. When further investigation was needed, fiber-optic endoscopic swallow studies, ultra- sonic evaluation of the tongue base, neck CT, and 24- hour double-probe pH monitoring were also undertaken.Results: A diagnosis of a swallowing disorder prema­ türe spills, pulling in the vallecula and/or pyriform sinuses, penetration and/or aspiration, and delayed swallow reflex was made in 164 patients. Dysphagia arose from a mechanical cause in 55%, and from a neurological cause in 32%. A multiphase rehabilitation program was initiated, which included positioning, adjusting bolus con- sistency, oral-motor range of motion exercises, use of palatal devices and swallowing techniques. Rehabilitation resulted in normal swallowing in 128 patients 78% .Conclusion: Mechanical causes should also be sought in patients with swallowing disorders.

Keywords

• Deglutition disorders/etiology/diagnosis/therapy, endoscopy, digestive system, fluoroscopy, manometry, oropharynx, peristalsis

Yutma bozukluğu olan hastalarda rehabilitasyon yöntemleri ve sonuçları

Abstract

Amaç: Yutma bozuklukları kulak burun boğaz pratiğinde sık karşılaşılan bir durumdur ve disfaji, tanı vetedavisinde güçlüklerle karşılaşılan bir semptomdur.Bu çalışmada yutma bozukluğu olan hastalar değerlendirmeye alındı. Hastalar ve Yöntemler: Kliniğimize Ekim 2000-Haziran 2002 tarihleri arasında yutma sorunları nedeniyleyutma polikliniğine başvuran 280 hasta 153 erkek, 127kadın; ort. yaş 53; dağılım 3-98 yaş incelendi. Hastaların ayrıntılı öyküsü alındı; yutma değerlendirme anketformu ile yakınmaları değerlendirildi; kliniğimizin tanıprotokolüne göre servikal oskültasyon, modifiye baryumlu yutma çalışmaları uygulandı; gerektiğinde fiberoptik endoskopik yutma, dil kökü ultrasonografisi, boyun tomografisi veya reflü açısından çift problu özofajeal pH metre çalışması da tanıya yardımcı yöntemlerolarak eklendi.Bulgular: Değerlendirme sonrasında 164 hasta yutmabozukluğu tanısı ile göllenme, prematür kaçak, penetrasyon/aspirasyon ve gecikmeli yutma yutma rehabilitasyonu programına alındı. Disfajinin hastaların%55’inde mekanik kökenli, %32’sinde nörolojik kökenliolduğu belirlendi. Rehabilitasyon çok aşamalı olarakpozisyonlama, kıvam ayarlama, oral-motor açıklık vekuvvetlendirme egzersizleri, yutma apereleri ve yutmateknikleri olarak uygulandı. Tedavi sonrasında 128hasta %78 normal yemek yemeye başladı.Sonuç: Yutma bozukluğu olan hastalarda mekaniknedenlerin de incelenmesi gerektiği kanısına varıldı

Keywords

• Yutma sorunları/etyoloji/tanı/tedavi, endoskopi, sindirim sistemi, floroskopi, manometri, orofarenks, peristaltizm.

References

1. Logemann JA. Factors affecting ability to resume oral nutrition in the oropharyngeal dysphagic individual. Dysphagia. 1990;4:202-8.
2. Logeman J. Evaluation and treatment of swallowing disorders. San Diego, College Hill Press 1983;11-36.
3. Strand EA, Miller RM, Yorkston KM, Hillel AD. Management of oral-pharyngeal dysphagia symptoms in amyotrophic lateral sclerosis. Dysphagia 1996;11:129-39.
4. Breen K. Dysphagia: dysphagia and other esophageal problems. Modern Medicine 2001;18:47-52.
5. Logeman J. Therapy for orophayngeal swallowing dis- orders. In: Perlman AL, Schultze-Delrieu K, editors. Deglutition and its disorders. 2nd ed. San Diego: Singular Publishing; 1997. p. 449-63.
6. Groher ME, Dysphagia: Diagnosis and management, 2nd ed. Boston: Butterworth-Heinemann 1992.
7. Schulze-Delrieu K, Miller RM. Clinical assessment of dysphagia. In: Perlman AL, Schultze-Delrieu K, edi- tors. Deglutition and its disorders. 2nd ed. San Diego: Singular Publishing; 1997. p. 125-53.
8. Yorkston KM, Miller RM, Strand EA. Amyotrophic lat- eral sclerosis. In: Management of speech and swallow- ing in degenerative diseases. 1st ed. Tucson: Communication Skill Builders; 1995. p. 3-86.

9. Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspi- ration. Ann Otol Rhinol Laryngol 1991;100:678-81.
10. Kidder TM, Langmore SE, Martin BJ. Indications and techniques of endoscopy in evaluation of cervical dys- phagia: comparison with radiographic techniques. Dysphagia. 1994;9:256-61.
11. Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154:965-74.
12. Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modi- fied barium swallow. Dysphagia 2000;15:136-41.
13. Teasell RW, Finston HM, Greene-Finestone L. Dysphagia and nutrition following stroke. Phys Med Rehabil 1993;7:89.
14. DePippo KL, Holas MA, Reding MJ, Mandel FS, Lesser ML. Dysphagia therapy following stroke: a controlled trial. Neurology 1994;44:1655-60.
15. Cherney LR, Halper AS. Swallowing problems in adults with traumatic brain injury. Semin Neurol 1996;16:349-53.