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[Dysphagia] audible swallow
I am currently seeing 2 patients with this characteristic.
1. Tonsillar cancer; s/p right rad neck dissection with chemo and
radiation. Had a very audible swallow (dare I use the word 'squishy' to
describe it) with a heavier pureed consistency (i.e. tapioca)--unable to
clear and required expectoration of the bolus. I happened to have a repeat
MBSS scheduled since I am doing vital stim with him, so I was able to get a
visual. He had a significant increase in post-swallow residue in the
pyriforms with this consistency and because of the cricopharyngeal
dysfunction the residue scattered all around the posterior pharyngeal wall
and the laryngeal vestibule. I recommended dilatation, which he just had
done this week and treatment was resumed. He ate a whole container of
tapioca during treatment and that audible (squishy) swallow was eliminated.
The gastro doc said he could not believe any food/liquid passed into the
esophagus (but, it did when is was smooth and thinner--the more his
pharyngeal strength improved, the more the bolus passed to the esophagus, so
this problem was not identified until this point in tx). Next dilatation is
in 2 weeks.
2. Second pt is an ACDF (C4-7) with a plate, who had pharyngeal dysphagia
due to edema. Now edema is resolving, but the pt is left with an audible
('clicking') swallow only with thin liquids (inconsistent--about 75% of the
time). No clinical s/s of aspiration noted and clear vocal quality.
This discussion has been very helpful and insightful in regards to these
patient. I only saw a MBSS on the first pt, but I felt that clinically they
both appeared safe in terms of airway protection. Thank you..........would
love to hear more insight regarding this characteristic in the ACDF
population if it is out there.
----- Original Message -----
From: "Houts, Karen L" <KHouts@stanfordmed.org>
To: <dysphagia@b9.com>
Sent: Thursday, September 01, 2005 1:23 PM
Subject: RE: [Dysphagia] audible swallow
I have seen some pts that have a audible galuping sort of sound, for lack of
a better way to describe it. On the VFS the bolus was poorly controlled.
The valleculae & especially the pyriforms were well filled before the
swallow. This galuping sound was consistently timed with the retropulsion of
the material in the pharynx as the swallow was initiated & the structures
began to rise. I dont know if what we heard was the actual motion of the
material or the air being pushed thru the material as the area is
compressed. However each of these people had good airway protection so it
wasnt that important. I just consider the sound a bit of a red flag that may
or may not require any intervention depending on the rest of the picture.
Karen Houts OTR/L-SWC
-----Original Message-----
From: dysphagia-bounces@b9.com on behalf of M. Tervo
Sent: Tue 8/30/2005 5:19 PM
To: dysphagia@b9.com
Cc:
Subject: [Dysphagia] audible swallow
I heard at a conference that a audible swallow is a disordered swallow. I
have been unable to locate any info that explains the details of this...can
anyone please explain this further?
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