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[Dysphagia] post Mitral valve replacement
How is this the pt's voice? It is not unlikely that this problem may be due to trauma to the vagus, not uncommon in any chest surgery (heart, lung, etc). It will take time, and intensive therapy. I doubt that the problem is due to intubation. Your therapy should include sensory activities, as well as any exercises designed to isolate pharyngeal activity. Be patient and as positive as possible for the patient's sake as well as yours. Be sure to maintain a healthy oral environment, and keep the pharyngeal segment free of pooled secretions as much as possible, if this is a problem as well. You didn't mention anything about is nutrition, therefore if this is also a problem, I would higly reommend that you work closely with your dietary folks to ensure adequate nutritional intake, even if it means a PEG for the near-term.
John
-----Original Message-----
From: adebin at bigpond.net.au
To: dysphagia at b9.com
Sent: Thu, 14 Dec 2006 8:24 AM
Subject: [Dysphagia] post Mitral valve replacement
A 63 year old man who was intubated in ICU for some time (I dont
remember how long) presented with profound dysphagia when doctors tried
to reintroduce oral intake. VF showed poor bolis driving force and
pharyngeal weakness. There was no epiglottic inversion and stasis in
the vallecuale failed to empty despite attempts at multiple swallows
effortfulswallows or flushing with liquid. Does anyone have any
suggestion particularly for epiglottic tilt probs I know this is a
difficult one. I have him tilting to the side which has significantly
helped though progress is probably not as quick as I would like in
terms of recovery from what I feel is localised trauma.
Aviva Debinski
Ph: +61 3 95762116
Fx: +61 3 95096021
Email: adebin at bigpond.net.au
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