Chapter 130 - Dysphagia

Abstract

Dysphagia generally refers to any difficulty with swallowing, including occult or asymptomatic impairments. Dysphagia can result from a wide variety of functional or structural deficits of the oral cavity, pharynx, larynx, or esophagus. Severe dysphagia may result in serious complications such as aspiration pneumonia, airway obstruction, malnutrition, dehydration, and death. The goal of dysphagia rehabilitation is to identify and treat abnormalities of feeding and swallowing while maintaining safe and efficient alimentation and hydration. The bedside swallow evaluation is an important step in the clinical evaluation. Although screening tests can be useful in screening for dysphagia, these examinations are limited in their ability to detect and to characterize dysphagia, so instrumental studies are usually necessary. The videofluorographic swallow study (VFSS) is the gold standard in dysphagia diagnosis and management. During the VFSS, the patient ingests radiopaque foods and liquids and oral, pharyngeal, and esophageal stages of swallowing physiology are evaluated. The results of the study are used to develop a plan for an appropriate diet, therapeutic compensations, and swallowing exercises. Rehabilitation of swallowing can involve structured swallowing therapy, surgical management, and pharmacologic management. An important consideration in dysphagia rehabilitation is maintaining adequate alimentation and hydration.