[Dysphagia] dysphagia immediately s/p radation treatment

[Julie-Ennis at smh.com (Julie Ennis)]

I'll try to keep this brief, but I just wanted to see if anyone had any other tidbit of advice or information...
 
59 y.o male.  3months out of radiation treatment for head/neck CA (laryngeal), attempted to swallow but reportedly kept "bringing everything back up". Had an MBS, (decreased base of tongue retraction and decreased laryngeal elevation. Epiglottic inversion was incomplete.  Pharyngeal residue was mild-moderate in the valleculae and  pyriforms  following all consistencies.  Aspiration occurred during subsequent swallows of the thin liquid and pudding, due to pharyngeal residue.  Cough was productive in clearing pharyngeal residue as well as penetrated/aspirated material.    Penetration occurred with all consistencies due to pharyngeal residue. 
 
Now 5 months post radiation, and only able to keep 2-3 bites of thick puree down, before "bringing it back up".  Patient has been completing pharyngeal exercises (for what they are worth).  Patient continues to have a significant amount of mucous.  He is convinced he would be able to swallow, if he didn't have the mucous.  He has been given various medications by his physicians to try to decrease the mucous without success. he hasn't had any kind of GI work up yet... and seems a little reluctant to go this route right now.  
 
1.Any suggestions on how else to decrease mucous?
2. patient has also asked about hyperbaric treatment.  does anyone have any experience with this population and this treatment?
3.  Any other suggestions on how to proceed?  Other than just letting time take its course?
 
thanks 
 
 
Julie Ennis, M.Ed, CCC-SLP
Sarasota Memorial HealthCare System
941-917-1395