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[Dysphagia] Oral thrush



 It is very possible that the patient has thrush in his larynx.  With the history of lung cancer and its treatment (XRT and/or Chemo) reducing immunity and upseting the GI tract flora.  We have seen some patients with this.  Sounds like the patient at least has pharyngeal thrush if it that painful to swallow, and the mucosa is continuous between the larynx and pharynx.
 
Scott Dailey, MA, CCC-SLP
Speech-Language Pathologist
University of Iowa Hospitals and Clinics

	-----Original Message----- 
	From: dysphagia-bounces@b9.com on behalf of Deanna Rolfe 
	Sent: Wed 4/19/2006 12:29 AM 
	To: TBAGGS@astate.edu; dysphagia@b9.com; Paula.Leslie@newcastle.ac.uk; pressmah@sjhmc.org; pawprint1980@yahoo.com.au 
	Cc: 
	Subject: RE: [Dysphagia] Oral thrush
	
	

	Could oral thrush cause dysphonia (assuming that it is in the larynx too...hasn't been visualized)??
	
	I have a patient who has very bad oral thrush, who says its like swallowing razor blades, who has lost his voice also in the last couple of days (intermittent aphonia, but voicing is very breathy when achieved).
	
	He has lung cancer, so the thought also crossed my mind that there may be some other nasty involved in the voice loss, but wondered about the thrush first.
	
	Deanna
	Australia
	
	>>> "Pressman, Hilda" <pressmah@sjhmc.org> 19/04/2006 12:20:30 am >>>
	Thrush looks like curdled milk.  It is related to immune suppression but can even occur in individuals who have only been on antibiotic.  It can be quite painful.  In the mouth I have seen it on the tongue, palate and gums.  It can also be present in the esophagus and can cause painful swallowing.  It is responsive to meds, however the esophageal thrush takes much longer to clear up than the oral thrush.  Hilda Pressman MA, CCC SLP BRS-S
	
	-----Original Message-----
	From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
	Behalf Of TERRY W. BAGGS
	Sent: Wednesday, April 12, 2006 9:50 AM
	To: Paula leslie; Alexandra Mitchell; dysphagia
	Subject: RE: [Dysphagia] Oral thrush
	
	
	I find that most new folks (students, CFs, etc) tend to confuse simple
	oral gunk with thrush.  A pretty good way to tell the difference is to
	try to remove it.  Oral gunk will come off.  Thrush will not.  I always
	go to the nurse in charge of that patient.  Oftentimes, they're so busy
	with other things, they have no clue about the thrush.
	
	
	
	-----Original Message-----
	From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
	Behalf Of Paula leslie
	Sent: Wednesday, April 12, 2006 1:29 AM
	To: Alexandra Mitchell; dysphagia
	Subject: RE: [Dysphagia] Oral thrush
	
	Hi Alexandra
	
	I'm not the best oral examiner in the world so I probably over estimate
	but
	these look like many of the mouths I see on the wards.  I am obsessed
	about
	oral hygiene.  If in doubt I always mention it to the nurse or HCA,
	often
	gently like "is this person receiving any treatment for an oral
	infection?" 
	to find out if the med team already know. If they do that's great and
	then I
	go on about oral health and chest infections (ad nauseam... does get the
	
	message through), and how painful mouths affect eating and swallowing.
	So how
	great it is that they're treating it.
	
	If they aren't treating then I ask them to come and have a look and "oh
	is
	that thrush etc?" Then I go on about oral hygiene and chests..... you
	know. 
	So - get it treated.  If it's bad enough I'll say that they might want
	to
	consider non-oral supplementation because the pt is never going to
	manage
	adequate hydration and nutrition orally.
	
	But cases differ, most of mine are elderly care, H&N is different, Ca is
	
	different.  If any hint of it then do mention it, it's up to the med
	team to
	decide what to do, but you can give them some info on oral hygiene,
	chests,
	hydration and nutrition etc that will help inform their decision.
	
	And some lovely pictures for (UK) breakfast time!
	
	Good Luck!
	
	Paula
	
	
	
	http://www.lib.uiowa.edu/hardin/md/dermnet/thrush.html
	
	http://images.google.com/imgres?imgurl=http://www.lib.uiowa.edu/hardin/m
	d/pictures22/cdc/PHIL_2925_lores.jpg&imgrefurl=http://www.lib.uiowa.edu/
	hardin/md/cdc/2925.html&h=476&w=700&sz=24&tbnid=ViT9RpqPxz_10M:&tbnh=93&
	tbnw=138&hl=en&start=5&prev=/images%3Fq%3D%2Boral%2Bcandida%26svnum%3D10
	%26hl%3Den%26lr%3D%26rls%3DRNWE,RNWE:2005-51,RNWE:en>===== Original
	Message From Alexandra Mitchell <pawprint1980@yahoo.com.au>
	=====
	>Hello everyone,
	>
	>  I am fairly new to speech pathology and I was wondering if someone
	could
	inform me about:
	>
	>   What oral thrush looks like and
	>   When it is significant/severe enough to inform the medical team that
	they
	need to do something about the amount etc
	>  Thanks so much for any information
	>
	>  Alexandra
	
	Paula Leslie
	Degree Programme Director
	RCSLT Specialist Advisor in Dysphagia
	
	Surgical and Reproductive Sciences
	Faculty of Medical Sciences
	University of Newcastle
	Newcastle upon Tyne
	NE2 4HH
	UK
	? (0) 191 222 6279(T)/8988(F)
	http://www.ncl.ac.uk/sars/postgrad/MSc.htm
	
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