Dysphagia Etiologies And Evaluation

Front 1

List various acute structural changes which can cause dysphagia

Back 1

Accidental Trauma
Medical/surgical trauma:
-Endotracheal intubation=VF paralysis
-Tracheotomy=decreased elevation of the larynx, decreased subglottic pressure, delayed and incoordinated laryngeal closure
-Cervical spine surgery
-Carotid endarectomy= damage to RLN

Front 2

List various structural changes secondary to infection, chemical agents, and toxins which can cause dysphagia

Back 2

Candidiasis
Infections- botulism, herpes, epiglottitis, pharyngitis
Chemical agents- stenosis of esophagus

Front 3

List various progressive transformation which can cause dysphagia

Back 3

Osteophytes, esophageal abnormalities (Zenker's Diverticulum, Lateral pharyngeal pouches), GERD, Esophagitis, strictures, webs, hiatal hernia

Front 4

What is the most frequent cause of structural dysphagia?

Back 4

Head and neck cancer and related surgeries including lip resection (loss of oral sphincter),floor of mouth resection, mandibulectomy, glossectomy, and surgery of the palate

Front 5

What are some treatment methods used for pt after oral cancer surgery?

Back 5

Oral motor- resistive exercises, ROM exercises, biofeedback.
Sensory stimulation- thermal tactile stim, bolus temp and taste modifications
Intra-oral prosthetics- palatal lift, palatal obturator, reshaping prothesis

Front 6

List some surgical treatments for laryngeal cancer?

Back 6

Supraglottic - removal of hyoid bone and top of larynx.
Glottic - includes one (hemi) or both VFs
Subglottic

Front 7

List aspects of radiation treatment which can cause dysphagia

Back 7

-xerostomia
-radio necrosis (breakdown of tissue and bone)
-edema
-sensory changes
-tissue fibrosis
-trismus (lock jaw)

Front 8

How can anterior cervical spine surgery cause dysphagia?

Back 8

Because the procedure can cause swelling of the pharynx, hypertonicity of the UES, or damage to the RLN (motor nerve for larynx), SLN (motor and sensory for cricothyroid), or glossopharyngeal (sensory for trigger of pharyngeal swallow).
Effects are usually only short term.

Front 9

What is the nerve damage associated with skull base surgery which can cause dysphagia?

Back 9

Trigeminal V- Impaired oral prep and transport
Facial VII- Drooling, pocketing, impaired oral preparation
Glossopharyngeal IX- delayed trigger of pharyngeal swallow
Vagus X- nasal reflux, stasis and pooling, aspiration
Hypoglossus XII- decreased oral sensitiviy and impaired oral prep and transport

Front 10

How does a tracheotomy affect swallowing?

Back 10

Reductions in subglottic pressure, protective cough, sense of smell, mucosal sensitivity, VF closure and coordination, and laryngeal elevation. Also disruption of respiration/swallow cycle, and prolongation of pharyngeal transit time (leads to asp).

Front 11

Name the causes and sx of Zenker's Diverticulum.

Back 11

Caused by failure of the UES to open when the bolus arrives.
Sx include:
-noisy swallowing
-dysphagia
-aspiration
-coughing
-regurgitation
-weight loss

Front 12

Describe conditions associated with ALS and how they may affect swallowing.

Back 12

ALS is a progressive neurogenic condition which involves atrophy of LMNs (motor nuclei) and UMNs (corticospinal and bulbar tracts) resulting in progressive loss of muscle and sensory functions.

Front 13

What are the symptoms of a CVA which affect swallowing and which CVA pt are more likely to have dysphagia?

Back 13

Sx include reduced lingual control, delayed trigger of swallow, decreased pharyngeal contraction, decreased laryngeal elevation, stasis, penetration, and aspiration. Those with an increased area of damage, right hemisphere, or brain stem stroke have a higher incidence of dysphagia.

Front 14

Which factors associated with Parkinson's Disease can cause dysphagia?

Back 14

Cognitive impairment, drooling, jaw rigidity, head and neck posture, upper extremity dismotility, impulse feeding, pharyngeal and esophageal motility problems, LES abnormalities, and oral phase abnormalities.

Front 15

Which factors associated with Myastenia Gravis result in dysphagia?

Back 15

Muscle fatigue can lead to nasal regurgitation, weak mastication, and poor palatal elevation. Liquids are easier to swallow b/c less oral prep is required.

Front 16

What are some other progressive neurological diseases which can cause dysphagia?

Back 16

OPMD, Duschenne's MD, PSP

Front 17

How does TBI affect a person's ability to swallow? (motor and conitive deficits)

Back 17

Motor deficits include delayed or absent pharyngeal response, decreased lingual control, and decreased pharyngeal clearance. Cognitive deficits include attention problems, impulsivity, agitation, memory problems, and decreased higher reasoning skills.

Front 18

What is achalasia of the esophagus and how can it be treated?

Back 18

Failure of the LES to relax resulting in a feeling of food stuck in the throat. Can be treated by botox or balloon dilation. Dx is confirmed manometrically.

Front 19

What are some other esophageal disorders which can cause dysphagia?

Back 19

Curling
Diffuse esophageal spasm
Nonspecific esophageal motility disorders
Esophageal diverticuli (Zenker's)
Webs/rings (Schatzki's)

Front 20

What are some causes of GERD?

Back 20

-Inappropriate relaxation of LES
-Increased abdominal pressure or stress
-UES dysfunction
-Decreased or incompetent LES pressures

Front 21

What is LPR and what are the sx?

Back 21

Laryngopharyngeal reflux.
Sx include:
-dysphagia
-odynophagia
-hoarseness
-vocal granulomas
-coughing/phlegm
-edema of larynx

Lack of heartburn with this condition distinguishes it from GERD.

Front 22

What are some infectious diseases which can cause dysphagia?

Back 22

-tonsillitis
-pharyngitis
-abscesses
-candida
-esophagitis
-Chaga's Disease = achalasia
-Deep neck infections
-Epiglottitis

Front 23

What are some autoimmune disorders which can cause dysphagia?

Back 23

-Crohn's
-HIV
-Wengener's
-Sjogren's Syndrome
-Rheumatoid arthritis

Front 24

What are some medications which can lead to dysphagia?

Back 24

-antiinflammatories
-antihypertensives
-antispasmodics
-antihistamines
-chemo drugs
-neurologic meds

Front 25

How can neoplasms/tumors cause dysphagia?

Back 25

Distortion, obstruction, reduced mobility, or neuromuscular/sensory dysfunction of the upper digestive tract.

Front 26

What is MS and how can it cause dysphagia?

Back 26

MS is a demyelinating disease.
Sx which can cause dysphagia include spasticity, incoordination, and disordered brainstem and cerebellar functions which can lead to delayed and incoordinated laryngeal and pharyngeal functions.

Front 27

What is silent aspiration, how often does it occur, and how can it be detected?

Back 27

When material passes below the VFs w/o any outward signs of difficulty. It occurs in up to 40% of patients with dysphagia. Signs include fever, and wet/hoarse vocal quality. It can be detected by testing for reflexive cough (FEESST).

Front 28

What are the pharyngeal stage sx of dysphagia?

Back 28

-delayed trigger of the swallow
-penetration
-aspiration
-reduced hyolaryngeal elevation
-vallecular stasis
-pyriform sinus stasis
-pharyngeal stasis
-nasal regurgitation

Front 29

What is the usual order of treatments approach?

Back 29

1. Postural adjustments
2. Sensory stimulation to increase oral sensation
3. Swallow modifications
4. Diet modifications

Front 30

What are the key components of the oral-pharyngeal exam at bedside?

Back 30

Observe for symmetry, fx, and involuntary movements:
-mandible
-lips
-tongue
-velum
-reflexes
Additional info:
-numbness
-dysphonia
-dysarthria
-breath support

Front 31

What are you looking for when you read the case history?

Back 31

-Feeding method (NPO?)
-history of aspiration pneumonia?
-risk of aspiration?
-status of oral mechanism
-nutritional status
-referral needed?
-cognitive status- capable for instrumental exam?
-modifications or recommendations for tx

Front 32

What are the three parts of the dysphagia eval?

Back 32

1. Case history
2. Bedside/clinical eval
3. Instrumental eval

Front 33

What do the three components of the dysphagia eval address?

Back 33

1. swallow safety
2. nutritional status
3. diet
4. need for specialized tx
5. referrals
6. medical dx
7. need for further assessment

Front 34

What are four patient self-assessment tools?

Back 34

1. SWAL-QOL
2. SWAL-CARE
3. RSI
4. MDADI (after HNC)

Front 35

What are three screening tests for dysphagia?

Back 35

1. Burke Dysphagia Screening Test (BDST)
2. Blue dye test (tracheotomy)
3. Auscultation

Front 36

What are the key components and information sources for the dysphagia case history?

Back 36

-chief complaint or current status
-onset/progression
-sx
-recent hospitalizations
-present/past illnesses
sources include:
-family
-observation
-medical records

Front 37

What are the common clinical findings for dysphagia?

Back 37

-penetration, aspiration
-pneumonia/spiking
-coughing/choking
-throat clearing
-pocketing/drooling
-wet vocal quality
-multiple swallow pattern
-increased time required to eat at meal

Front 38

What does the MBS evaluate and what can it determine?

Back 38

Evaluates- bolus formation, tongue motion, coordination, timing, completeness of swallowing, mvmt of epiglottis, elevation of larynx, and cricopharyngeal contraction.
It can determine the cause of aspiration.

Front 39

What is manometry and what can it determine?

Back 39

Measure of pressure which determines esophageal motility disorders and assesses dx of esophageal sphincters. Also looks at pharyngeal propulsion.

Front 40

What are some other instrumental tests for dysphagia?

Back 40

Ultrasound- oral and oropharynx
MRI/CT
Scintigraphy
EMG
PET