Swallowing Disorders Chapter 3

*Instrumental Techniques

*Imaging Studies

*Imaging Studies

*Ultrasound

*Videoendoscopy

*Videofluoroscopy

*Scintigraphy

*Ultrasound

*Observe tongue function

*Measures oral transit times

*Measures motion of the hyoid bone

*No visualization of the pharynx

*Limited study

*Videoendoscopy

*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

*Videoendoscopy

*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

*Videofluoroscopy

*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

*Videofluoroscopy

*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

*Scintigraphy

*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

*Nonimaging Procedures

*Electromyography

*Electroglottography

*Cervical Auscultation

*Pharyngeal Manometry

*Electromyography

*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

*Electroglottography

*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

*Cervical Auscultation

*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

*Cervical Auscultation

*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

*Pharyngeal Manometry

*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

*Pharyngeal Manometry

*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