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[Dysphagia] RE: audible swallow
- Subject: [Dysphagia] RE: audible swallow
- From: Isabelle_Sutula at mhhs.org (Sutula, Isabelle)
- Date: Fri Sep 2 09:29:05 2005
I have an audible swallow and I have always felt it was an advantage in dysphagia therapy.
-----Original Message-----
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Sent: Friday, September 02, 2005 9:02 AM
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Subject: Dysphagia Digest, Vol 22, Issue 2
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Today's Topics:
1. Re: audible swallow (Theresa Szmansky)
2. FWD: urgent query! (Paula leslie)
3. Re: audible swallow (Theresa Szmansky)
4. UK Swallow Research Group (Paula leslie)
5. RE: audible swallow (marc rosenblatt)
6. Home/Study CEU courses (Bartcyn@cs.com)
7. Re: audible swallow (Alicia Multari)
----------------------------------------------------------------------
Message: 1
Date: Thu, 1 Sep 2005 15:37:31 -0400
From: "Theresa Szmansky" <tszmansky@pobox.com>
Subject: Re: [Dysphagia] audible swallow
To: <dysphagia@b9.com>
Message-ID: <009b01c5af2c$9a0bbed0$640fa8c0@Derxst>
Content-Type: text/plain; format=flowed; charset="utf-8";
reply-type=original
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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------------------------------
Message: 2
Date: Thu, 1 Sep 2005 21:08:21 +0100
From: Paula leslie <Paula.Leslie@newcastle.ac.uk>
Subject: [Dysphagia] FWD: urgent query!
To: Dysphagia List <dysphagia@b9.com>
Message-ID: <4310BCA7@webmail.ncl.ac.uk>
Content-Type: text/plain; charset="ISO-8859-1"
Hello All
Just got this from a colleague of mine. I'm not an ALD expert. Can anyone
help?
Thanks
Paula
hi - can anyone help with the query below - will collate and send on!
many thanks -
....
We are having a difficult, diplomatic issue with a local consultant who
is adamant that a lady with Downs dementia and dysphagia should not be
PEG fed as the consultant believes that this would merely prolong her
life unnecessarily. The consultant's belief is that our experience is
not replicated in the community where the consultant claims clients die
soon after the onset of dysphagia, although we suspect this is because
such patients dies from lack of nutrition, not from the dementia. This
has been an issue with other consultants in the past, but this
particular discussion is causing us some difficulty.
The local consultant is asking for evidence to support our experience
that
1) Dysphagia occurs in the middle/late third of the condition, not as a
new symptom in the terminal stages (ie hours or days) as in other forms
of dementia.
2) PEG feeding improves the quality of life of these patients by
reducing chest infections and preventing symptoms of malnourishment
3) Not inserting a PEG results in a prolonged illness of repeated chest
infections and malnutrition symptoms which, if the patient can manage
some feeding, may go on for more than 6 months (18 months in one of our
ladies).
Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
+44 (0) 191 222 6279(T)/8988(F)
http://www.ncl.ac.uk/sars/postgrad/MSc.htm
------------------------------
Message: 3
Date: Thu, 1 Sep 2005 22:32:48 -0400
From: "Theresa Szmansky" <tszmansky@pobox.com>
Subject: Re: [Dysphagia] audible swallow
To: <slpinor@isp.com>
Cc: dysphagia@b9.com
Message-ID: <001d01c5af66$9c00cbb0$640fa8c0@Derxst>
Content-Type: text/plain; format=flowed; charset="utf-8";
reply-type=response
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?
>>
>>
>>
>>
>> ---------------------------------
>> Start your day with Yahoo! - make it your home page
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>>
>>
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>>
>
>
------------------------------
Message: 4
Date: Fri, 2 Sep 2005 09:58:45 +0100
From: Paula leslie <Paula.Leslie@newcastle.ac.uk>
Subject: [Dysphagia] UK Swallow Research Group
To: Dysphagia List <dysphagia@b9.com>
Message-ID: <4310EB24@webmail.ncl.ac.uk>
Content-Type: text/plain; charset="ISO-8859-1"
1st UKSRG Conference
London
2nd December 2005
It is with the greatest pleasure that we announce the first UK swallowing
research group conference to be held at the British Medical Association,
London.
The group recognize the multidisciplinarity of the clinical specialties and
basic science that supports developments in the field and we will be running
an annual conference.
Aims:
To disseminate and debate the latest swallowing research
To bring researchers together from basic science and clinical practice to
share ideas and develop research projects
To encourage peer review and support for work in progress
Presentations in the first conference will be given by:
Dr David Smithard Stroke Physician
Prof Michael Polki Respiratory Medicine (Keynote)
Prof Angus Walls Restorative Oral Health (Keynote)
Dr Michael Drinnan Medical Physics
Dr Lin Perry Stroke Nursing
Mr Steve Davies Dysphagia Nurse
Ms Annette Kelly Head & Neck Dysphagia SLT
Dr Shaheen Hamdy Gastroenterology
Dr Maxine Power Stroke Medicine SLT
The programme for 2005 will cover the interface between respiration, oral
health and swallowing, advances in swallowing assessment, and new and emerging
treatments. We hope you will be able to join us.
Registration ?120.00 (including lunch).
For further information please contact:
Maxine Power mpower@fs1.ho.man.ac.uk
Steve Davies steve.davies@ghnt.nhs.uk
David Smithard Dgsstroke@aol.com
Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
+44 (0) 191 222 6279(T)/8988(F)
http://www.ncl.ac.uk/sars/postgrad/MSc.htm
------------------------------
Message: 5
Date: Fri, 02 Sep 2005 07:03:11 -0400
From: "marc rosenblatt" <nando11504@hotmail.com>
Subject: RE: [Dysphagia] audible swallow
To: KHouts@stanfordmed.org, dysphagia@b9.com
Message-ID: <BAY105-F2A8EF36D18BD07A94278094A30@phx.gbl>
Content-Type: text/plain; format=flowed
someone once told me that they viewed the audible swallow as an "oh sh#t
swallow," that your body recognizes it needs to swallow b/c it may feel
material entering the upper airway.
>From: "Houts, Karen L" <KHouts@stanfordmed.org>
>To: dysphagia@b9.com
>Subject: RE: [Dysphagia] audible swallow
>Date: Thu, 1 Sep 2005 10:23:09 -0700
>
>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?
>
>
>
>
> ---------------------------------
> Start your day with Yahoo! - make it your home page
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>
>
>
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia
_________________________________________________________________
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------------------------------
Message: 6
Date: Fri, 02 Sep 2005 08:23:39 -0400
From: Bartcyn@cs.com
Subject: [Dysphagia] Home/Study CEU courses
To: dysphagia@b9.com
Message-ID: <44C7EC65.47DC4222.0015B7D3@cs.com>
Content-Type: text/plain; charset=iso-8859-1
The following CEU courses have been approved to offer for ASHA CEUs
A Comprehensive Compendium for Dysphagia Management 10 hours (1.0)CEUs $100
Introduction to Endoscopic Assessment of Swallowing 8 hours (.8) CEUs
$100
Prevention of Medical Errors for Speech Language Pathologists 2 hours (.2)
$60)
Email Cindy for a brochure
or go to www.ProCourseCEUs.com and click on home/study brochure
------------------------------
Message: 7
Date: Fri, 02 Sep 2005 09:33:20 -0400
From: "Alicia Multari" <MULTARIA@nychhc.org>
Subject: Re: [Dysphagia] audible swallow
To: <slpinor@isp.com>, "Theresa Szmansky" <tszmansky@pobox.com>
Cc: dysphagia@b9.com
Message-ID: <s3181c74.065@gwia.nychhc.org>
Content-Type: text/plain; charset="US-ASCII"
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?
>>
>>
>>
>>
>> ---------------------------------
>> Start your day with Yahoo! - make it your home page
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>>
>>
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>> _______________________________________________
>> Dysphagia mailing list
>> Dysphagia@b9.com
>> http://lists.b9.com/mailman/listinfo/dysphagia
>>
>>
>>
>
>
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