[Dysphagia] The (off)-beat goes on...

[eripley at yahoo.com (Irene Campbell-Taylor)]

Having just visited the dysphagiaonline website sponsored by Novartis, I don?t know whether to scream or cry. The continuing promulgation of misinformation is totally frightening. Some examples from the professional section:

?Swallowing requires the coordination of 25 muscles and 5 cranial nerves?.

 

-It?s SIX cranial nerves: V, VII, IX, X, XI and XII. Missing one can cause misidentification of the cause of the dysphagia.

 

?and the larynx moves upwards to prevent any food or liquid passing into the airways, which is aided by the backward tilt of the epiglottis and closure of the vocal folds?

 

- This is NOT what prevents food or liquid from entering the airways. This is achieved by pulling open the UES by traction of the hyoid  while the arytenoids move against the base of the epiglottis to seal the entry to the airway. One can swallow perfectly well without the blade of the epiglottis as long as the base is intact and the arytenoids move against it in proper timing. Also the order of events as described is inaccurate.

 

And, worst of all:

 

?Diagnosis of dysphagia
In the hospital setting, symptoms of dysphagia usually appear as an acute or chronic medical complication?

 

Dysphagia IS a symptom. It cannot be ?diagnosed? only identified.  This is not pedantry. To think of dysphagia as a disease entity precludes the essential first step of management ? identification of the CAUSE. Without knowing that, treatment is not possible. In some cases, no treatment is appropriate, only attempts at compensation but to make such a decisiion requires knowledge of the disorder responsible for the symptom and its prognosis as well as possible treatments for the causative disease. Others are quickly and completely remediable. I shudder to recall the number of times that I have been called to consult on a patient whose swallowing dysfunction was due entirely to a specific medication but who had been a) enterally fed with resultant chronic pneumonitis, b) put through a series of ?exercises? to no avail, c) denied water and other liquids with resultant dehydration and the inevitable problems with blood pressure, digestion etc.etc., d) given thickened everything with
 reduced intake and progressive malnutrition/dehydration. The dysphagia was  eliminated by discontinuing, replacing or changing the dosage of the medication in question. This is only one of many possible scenarios re the underlying cause of the symptom, dysphagia. Fuzzy thinking leads to errors that can be irreparable.



Dr I Campbell-Taylor
Clinical Neuroscientist
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www.interactivetherapy.com