Management of Dysphagia Requires a Team Approach

Dysphagia affects more than 20% of the population over the age of 50. Fortunately, newer diagnostics and treatment approaches are not only helping improve the care and quality of life for these patients, but have also expanded what the otolaryngologist can do.

Indeed, the otolaryngologist can deal with the diagnostics, and both the medical and surgical treatment. But a team approach, along with a mix of medical, behavioral, and surgical treatments, can provide even further benefits to patients. These were among the messages highlighted in a panel at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery on contemporary dysphagia management.

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Figure. Evaluation of swallowing is key to proper diagnosis and treatment of dysphagia.

We really advocate a team consisting of otolarygnologists and speech language pathologists as one-stop shopping for dysphagia, said Peter C. Belafsky, MD, PhD, Assistant Professor of Otolaryngology at the University of California, Davis, who moderated a panel that included otolaryngologic surgeons and a speech pathologist. Case studies were used to discuss diagnosis and treatments.

Case 1: Solid Food Dysphagia, Parkinson’s Disease

The first case was of a 77-year-old woman who suffered from solid food dysphagia. She’d had significant weight loss, minor dysphonia, a history of hypercholesteremia, coronary artery disease, and had a previous stroke with minor sequelae. She also had stable Parkinson’s disease. She had a voice handicap index of 28 and an Eating Assessment Tool (EAT-20) of 66.

Panelists agreed that taking the Parkinson’s disease into account was important, as it is a hypokinetic disorder that could limit tongue range and motion, or affect the pharynx or larynx.

A video fluoroscopic swallow exam was performed and showed regurgitation, a hypertrophic cricopharyngeous muscle, and a small Zenker’s diverticulum.

Gregory N. Postma, MD, Professor of Otolaryngology at the Medical College of Georgia, said that in patients such as this it’s critical that we know what’s going on south of this. It’s key to make sure the individual has reasonable esophageal motility. Allow the bolus to go a couple of inches further down before it obstructs. I always follow the video fluoroscopic study or manometry in someone like this.

Looking toward clinical management is important too, said James P. Dworkin, PhD, Professor of Otolaryngology and a speech pathologist at Wayne State University. The Parkinson’s disease could compromise how well the tongue, larynx, upper esophagus sphincter, and esophagus all function.