[Dysphagia] Fw:

[mzilberstein at msn.com (melissa zilberstein)]

----- Original Message ----- 
From: melissa zilberstein<mailto:mzilberstein@msn.com> 
To: mzilberstein@msn.com<mailto:mzilberstein@msn.com> 
Sent: Monday, January 09, 2006 9:13 PM



CERVICAL AUSCULTATION
YOUMANS, SR AND STIERWALT, AN ACOUSTIC PROFILE OF NORMAL SWALLOWING, DYSPHAGIA 20:2005. 195-209.

LESLIE, PAULA, RELIABILITY AND VALIDITY OF CERVICAL AUSCULATION, A CONTROLLED  COMPARISON USING VF, DYSPHAGIA, 19; 2004, 231-40.


THIS IS JUST MY PERSPECTIVE.
IN MY OPINION,PEOPLE HAVE DIFFERENT LEVELS  OF ABILITY TO PERCEIVE SOUND PATTERNS.

JUST LIKE THE MUSICIAN THAT LEARNS A REPETOIRE OF COMMON  SOUND PATTERNS IN MUSICAL LITERATURE, SCALES, ARPEGGIOS, VARIOUS CHORD
PROGRESSIONS AND LEARNS TO RECOGNIZE THEM, FOR THOSE WHO ARE TUNED IN THIS WAY WITH A MUSICAL EAR, COMMON SENSE COULD DICTATE THAT THE EAR COULD BE TRAINED TO ASCERTAIN  CERTAIN SOUNDS PATTERNS ASSOCIATED WITH CERTAIN BOLUS CONSISTENCIES IN DIFFERENT ANATOMIES.  PEOPLE HAVE DIFFERING RATES OF ABILITY IN EAR TRAINING. 
THEREFORE, INTERATER RELIABILITY COULD BE DIFFICULT IF ONE WAS AT VARYING LEVELS OF MUSICAL ABILITY  OR IF ONE HAD BLOWN OUT THEIR HEARING IN THE 80'S!

AS A MUSICIAN, A WELL TRAINED EAR COULD  EASILY PICK UP THE BASIC FREQUENCY OF A PATIENTS PHARYNX AND COMPARE BREATH SOUNDS BEFORE, DURING AND AFTER THE SWALLOW. AS SOLIDS ARE DENSE (ESPECIALLY PUREED BEEF AT OUR PLACE!)  THEY WOULD MOST LIKELY EMIT A LOWER FUNDAMENTAL FREQUENCY DEPENDING ON THE LENGTH, WIDTH OF THE NECK AND OF COURSE THE ADIPOSE TISSUE ABSORBING THE SOUND FREQUENCIES.
(ANOTHER REASON TO DIET!)

I THINK THAT ESPECIALLY FOR CLINICIANS WITH PERFECT PITCH, THIS TASK ISNT' DIFFICULT AT ALL, THUS WHY SOMEONE MAY BE ABLE TO IDENTIFY THE POSITION OF A SOLID.  AFTER ALL, IF ONE TUNES THEIR STRING INSTRUMENT OR DRUM, THEY TAP INTO THE SAME KIND OF AUDITORY FUNCTION. HAVE YOU EVER WATCHED A KETTLE DRUM PLAYER TUNE HIS DRUM?  EACH PART OF THE DRUM HAS A RESONANCE AND PITCH RANGE. NECKS ARE NOT THAT DIFFERENT, KIND OF LIKE HUMAN BONGOS!  THEY ARE ONLY SO WIDE AND SO LONG, THEREFORE THERE SHOULD BE  A RELATIVE GROUPING OF PITCH VARIATION AND RESONANCES AVAILABLE TO THE TRAINED EAR.

I THINK THAT CERVICAL AUSCULTATION IS A SCREEN WHICH CAN HELP IDENTIFY PATIENTS WITH THE POTENTIAL FOR SILENT ASPIRATION ALONG WITH TACTILE PALPATION. IF YOUR HAND CAN LEARN TO SENSE DIFFERENCES IN LARYNGEAL ELEVATION, YOUR EAR CAN LEARN AS WELL IF YOU ARE THAT TYPE OF LEARNER. DR. BOSMA TAUGHT A LOT OF US IN MARYLAND BACK IN THE 90'S AND IT WAS VERY COMMONLY PRACTICED THEN. I WAS CONFUSED ABOUT IT THEN, MORE THAN LIKELY BECAUSE EVERYTHING IN OUR FIELD WAS SO NEW AND MINDS WERE JUST PERKING AWAY, BUT THIS YEAR, I HAVE FOUND IT WORTH A REVISIT IN MY PRACTICE. 

I HAVE BEEN USING IT MORE AND I THINK IT IS CERTAINLY WORTH A LISTEN
TO REEVALUATE THIS PRACTICE AS IT IS SO NONINVASIVE.
I SUPPOSE THAT THIS WOULD VARY FROM SLP TO SLP BASED ON  THEIR HEARING ABILITY AND HOW THE AUDITORY CORTEX IN THAT PERSON
HAS DEVELOPED SOUND SENSITIVITY TO PATTERNS. ALSO, A PATIENT WHO MAY WHEEZE AFTER SWALLOWING ONE DAY AFTER EXTUBATION COULD BE DIFFERENT THE NEXT.

A VERY EASY TEST FOR YOUSELF WOULD BE TO AUSCULTATE USING GUIDELINES FROM ( I THINK HIS NAME WAS TAKAHACHI, A TOKYO RESEARCHER WHO PRESENTED AT JOHNS HOPKINS IN THE MID 90'S AT THE DYSPHAGIA CONFERNCE .) THEN WHEN YOU EVAL YOUR PATIENTS, COMPARE ON VF WHAT YOU THOUGHT YOU HEARD AGAINST WHAT YOU SEE. KEEP A LIST OF APPROXIMATE NECK SIZE AND LENGTHS VERSUS BOLUS SIZES AND TYPES. THEN YOU WILL HAVE YOUR OWN RESEARCH! AFTER ALL THE PURPOSE OF ALL OF THIS IS TO TRY AND IDENTIFY WHICH PATIENT'S ARE AT RISK OF SILENT ASPIRATION AND TREATMENT. WE ALL DO THE BEST THAT WE CAN IN RECOMMENDING PATIENTS FOR MBS'S. I DO NOT THINK THAT THE BEDSIDE ASSESSMENT IS AN EXACT SCIENCE ANYWAY. 

BETTER TO ERR ON THE SIDE OF CAUTION AND USE ALL OF YOUR CLINICAL KNOWLEDGE, LAB VALUES, PALPATION, CERVICAL AUSCULATION THAN
MISS A PROBLEM. AFTER ALL, IT ISN'T LIKE A TROOP OF VISCOMETER WIELDING SLPS' WILL ARREST YOU FOR DOING A MODIFIED BARIUM SWALLOW.
NOT THIS YEAR ANYWAY. I SHOULD THINK THIS IS WHERE THE ART IN OUR PROFESSION WOULD COME INTO PLAY.

SHALOM, MELISSA Z.