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About
Dysphagia
Swallowing problems (dysphagia)
have been found to occur in approximately 13 to 14 percent of all hospitalized
patients, 40 to 50 percent of patients in nursing homes and approximately 33
percent of the patients in rehabilitation centers. Among the more common
reasons for swallowing problems are sudden onset neurologic damage (e.g.
stroke, head injury or spinal cord injury), progressive neurologic disease
(e.g. Parkinson's disease, motor neuron disease, multiple sclerosis,
myasthenia gravis), head and neck tumors and their treatment and medical
problems such as rheumatoid arthritis, scleroderma and diabetes.
Patients with suspected
swallowing problems should be carefully evaluated and appropriate treatment
initiated in order to prevent complications from their swallowing disorders,
such as dehydration, malnutrition, choking and pneumonia. The New York Eye
& Ear Infirmary's Communicative Sciences Center has been evaluating and
treating patients with swallowing disorders since 1992. We provide complete
diagnostic and therapeutic intervention in our technologically advanced
Swallowing Laboratory. New instrumentation and training have spurred improved videoflouroscopic imaging, timing, and reading of the disordered swallow (procedures include fiberoptic endoscopic examination of the swallow (FEES), flexible endoscopic evaluation of swallowing with sensory testing (FEESST), electromyography, and the modified barium swallow).
Both pediatric and adult
clinical assessments are conducted routinely both for the Head and Neck
population and for patients with disorders related to GERD, trauma, neurogenic
etiologies, and laryngeal incompetence. Treatments include:
- Compensatory
Posturing
- Thermal Stimulation
- Therapy Techniques
- Adaptive Equipment
- EMG Monitored
Swallowing
- Consideration of
Medical-surgical Alternatives
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Normal Swallowing
Normal swallowing is rapid, safe and efficient and requires
less than 2 seconds. Normal swallowing of food and liquid requires
coordination of a large number of muscles in the mouth, throat (pharynx) and
esophagus (a tube that leads from the pharynx to the stomach). As food is
placed in the mouth, we close our lips to prevent drooling. Muscles of the
tongue and jaw move food around in the mouth for chewing. When chewing is
finished, the food is collected into a ball by movement of the tongue.
The
swallowing begins as the tongue pushes the food upward and backward toward the
back of the mouth and the throat. As this occurs, the muscles in the pharynx
begin to move to receive the food. The top of the windpipe (larynx) begins to
lift, move forward and close to keep food from going into the lungs. The soft
part of the roof of the mouth (the soft palate) lifts to close off the
entrance to the nose.
As
the food and liquid enter the pharynx, the muscles in the pharynx contract to
squeeze the food through the pharynx and into the esophagus. As the food
approaches the entrance to the esophagus, the valve at the top of the
esophagus opens to allow the food to pass. Muscles in the esophagus then
contract to push the food from the top of the esophagus through the valve at
the bottom of the esophagus and into the stomach.
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Common
Signs of Swallowing Disorders
You
May Have a Swallowing Disorder if You Experience:
- Coughing while eating or drinking or very
soon after eating or drinking
- Wet sounding voice during or after eating
- Increased congestion in the chest after
eating or drinking
- Slow eating
- Multiple swallows on a single mouthful of
food
- Obvious extra effort or difficulty while
chewing or swallowing
- Fatigue or shortness of breath while eating
- Temperature rise 30 minutes to an hour after
eating
- Weight loss associated with increased
slowness in eating
- Repetitive pneumonias
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Medical
Evaluation for Swallowing Disorders
If you see any of these signs or symptoms of a swallowing problem, the patient
should be given a complete medical evaluation by a physician and they should
be given an evaluation by a swallowing specialist (usually a speech-language
pathologist). Swallowing disorders are usually best treated by a
multi-disciplined team of medical professionals.
Members of the team include
otolaryngologists, the speech-language pathologists, the nurse practitioner,
the radiologist, the dieticians and when necessary, the neurologist and the
respiratory therapist. The speech-language pathologist acting as the
swallowing therapist coordinates the patient's treatment with the guidance of
the patient's physician.
Patients must consult with
an otolaryngologist who specializes in dysphagia before swallowing therapy or
a remediation plan may be undertaken by the Dysphagia Service. If you wish to
inquire about dysphagia services, please call 212-979-4340.
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Related
Information
The Voice and Swallowing Institute @ NYEE - This section provides educational information about swallowing and dysphagia. Topics include:
- Introduction to Swallowing
- General Information about Swallowing
- What is Dysphagia?
- Diagnosing Dysphagia
- Treating Dysphagia
- Glossary & Additional Resources for Swallowing Disorders
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