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[DYSPHAGIA] Trach and MBS
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I often receive videos for analysis and comment. Recently I saw one that =
begs a question that I sincerely hope someone will answer. The patient =
had a trach in place but was able to tolerate long periods with it =
corked and, shortly after this MBS was done, the trach was removed. This =
is a side issue and we'll leave, for the moment, the wisdom of =
performing MBS or VFSS of any kind with a trach in place.
There were only two lateral shots. No AP. In the first, there was some =
laryngeal elevation but NO hyoid movement - as expected in a lateral =
medullary stroke, which this patient had. The UES therefore, could not =
open and aspiration resulted.
The next thing is what I need some input about. For some reason, the =
clinician then had the patient occlude the stoma with his finger. This, =
of course, had the result of eliminating whatever laryngeal elevation he =
had which, coupled with the absence of hyoid movement made aspiration =
absolutely inevitable. Can anyone tell me why anyone would occlude the =
stoma with the finger in a case like this? For what reason? And, try it =
yourself. Put your finger at the usual location of a stoma and apply =
some moderate pressure. Then try to swallow.
Anyone? Please?
Irene.
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<DIV><FONT face=3DArial size=3D2>I often receive videos for analysis and =
comment.=20
Recently I saw one that begs a question that I sincerely hope someone =
will=20
answer. The patient had a trach in place but was able to tolerate =
long=20
periods with it corked and, shortly after this MBS was done, the trach =
was=20
removed. This is a side issue and we'll leave, for the moment, the =
wisdom of=20
performing MBS or VFSS of any kind with a trach in place.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>There were only two lateral shots. No =
AP. In the=20
first, there was some laryngeal elevation but NO hyoid movement - as =
expected in=20
a lateral medullary stroke, which this patient had. The UES therefore, =
could not=20
open and aspiration resulted.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>The next thing is what I need some =
input about. For=20
some reason, the clinician then had the patient occlude the stoma with =
his=20
finger. This, of course, had the result of eliminating whatever =
laryngeal=20
elevation he had which, coupled with the absence of hyoid movement made=20
aspiration absolutely inevitable. Can anyone tell me why anyone would =
occlude=20
the stoma with the finger in a case like this? For what reason? And, try =
it=20
yourself. Put your finger at the usual location of a stoma and apply =
some=20
moderate pressure. Then try to swallow.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Anyone? Please?</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Irene.</FONT></DIV></BODY></HTML>
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