[DYSPHAGIA] epiglottic inversion

[denisecomeau@hotmail.com (denise gabel-comeau)]

I am in need of your opinions and any treatment strategies for this complex 
patient.

This 77 y/o male was admitted S/P acute MI, right occipital lobe infarct 
11/14/01, CABG 11/7/01 and GI bleed 11/16/01.  Pt has been 
intubated/extubated x2 during this hospitalization. Bronchoscopy revealed a 
paralyzed vocal fold(did not indicate which side). PMH includes 
Parkinsons-moderately advanced. MBS completed 12/7/01 indicated frank silent 
aspiration with puree consistency, use of chin tuck increased amount of 
bolus aspirated, continued aspiration after the swallow secondary to 
pharyngeal residue, cued cough ineffective to clear aspiration, decreased 
laryngeal elevation and minimal to absent epiglottic inversion.
Are there any specific exercises to improve epiglottic inversion? Any 
suggestions for treatment would be appreciated.
Thank you,
Denise

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