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[Dysphagia] audible swallow


  • Subject: [Dysphagia] audible swallow
  • From: MULTARIA at nychhc.org (Alicia Multari)
  • Date: Fri Sep 2 07:34:22 2005

I just recently saw a patient with Anterior Cervical Disc Fusion as well and he complained of an audible swallow..we actually could hear the clicking. A FEES was performed without any type of oropharyngeal dysphagia, but with a sensation of food/pills getting stuck. During the eval, we showed him that everything appeared clear despite his sensation of food/pills feeling stuck. We referred him back to ENT with considerations for GI? or possibly MBS? Is there nerve innervation that could have impacted his sensation for swallowing? Or is it a motility issue?  What have you all experienced?

>>> "Theresa Szmansky" <tszmansky@pobox.com> 9/1/2005 10:32:48 PM >>>
Anterior Cervical Disc Fusion--sorry.

----- Original Message ----- 
From: "SLP" <slpinor@isp.com>
To: "Theresa Szmansky" <tszmansky@pobox.com>
Sent: Thursday, September 01, 2005 4:05 PM
Subject: Re: [Dysphagia] audible swallow


> Can you please clarify what teh ACDF means? thanks!
>
> Theresa Szmansky wrote:
>
>> 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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>
> 

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