Diagnosis, Treatment of Swallowing Disorders Require Focused Evaluation by Otolaryngologists

Generally, she added, dysphagia patients are “super, super motivated.” She added, “They want to eat. They want the symptom to go away. And they work hard.”

Case 3

A third case involved an 80-year-old woman three weeks after the excision of an inflammatory cystic neck mass. The internal jugular vein was sacrificed, but the recurrent laryngeal nerve was spared. Since the surgery, she had been hoarse with swallowing problems. An exam showed that the patient was suffering from left vocal fold immobility and was aspirating liquids.

Dr. Lintzenich asked whether the timing of intervention is affected by the presence of dysphagia in a patient with vocal fold paralysis, when recovery is expected. Dr. Merati answered with an emphatic “Yes.” “If you have a vocal fold paralysis without dysphagia, the urgency is different,” he said. “Aspiration and vocal paralysis is urgent. This is a typical inpatient consult. The reason to act today is their aspiration, not because of their voice.”

Dr. Postma noted the high mortality rate among elderly patients who get aspiration pneumonia.

The panelists agreed that, in this case, laryngoplasty was in order, but Dr. Postma said dysphagia results might be lacking. “You’ll improve their voice without question; you’ll improve their cough, usually dramatically,” he said. “The results, as far as [the] dysphagia itself, are not outstanding…. I tell my patients it’s a coin flip.”

Assessing swallowing requires an objective evaluation because patients will likely say they are swallowing better when they’re feeling better overall due to other improvements.

Dr. Amin said direct improvement of aspiration might not be the goal. “The goal may actually be to improve their cough, so that what they do aspirate they can eject back out again,” he said. “And that, I think, I can reasonably promise them.”