Treatment of oropharyngeal dysphagia
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Substantial ignorance and controversy surround the management of neuromyogenic pharyngeal dysphagia. The major obstacle to confident recommendations is the lack of high-level evidence supporting most available therapies. There is reasonable evidence supporting cricopharyngeal disruption (myotomy or dilatation) in primary restrictive disorders of this region, but low-level evidence supporting myotomy in pure neuromyogenic dysphagia. There is reasonable evidence supporting current dietary recommendations as aspiration-minimization strategies. There is only low-level evidence, albeit consistent, to support swallow-behavior modification therapies. The type of therapy needs to be tailored to the individual and depends upon many variables, including cognitive ability, severity and mechanics of pharyngeal dysfunction, and the perceived safety of continued oral feeding. One or more of these strategies are recommended where appropriate because where the level of evidence is low, it is at least consistently favorable and such therapies have not been proven to be ineffective.
KeywordsBotulinum Toxin Percutaneous Endoscopic Gastrostomy Aspiration Pneumonia Inclusion Body Myositis Oropharyngeal Dysphagia
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References and Recommended Reading
- 4.Anonymous: Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Summary, Evidence Report/Technology Assessment: Number 8. Rockville, MD: Agency for Health Care Policy and Research; 1999:1–6.Google Scholar
- 12.Eisenhuber E, Schima W, Schober E, et al.: Videofluoroscopic assessment of patients with dysphagia: Pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol 2002, 178:393–398.Google Scholar
- 14.Johnson ER, McKenzie SW, Sievers A: Aspiration pneumonia in stroke. Arch Phys Med Rehab 1993, 74:973–976.Google Scholar
- 17.Doggett DL, Tappe KA, Mitchell MD, et al.: Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidencebased comprehensive analysis of the literature. Dysphagia 2001, 16:279–295. Evidence-based review of swallow therapy.PubMedCrossRefGoogle Scholar
- 19.Chang MW, Rosendall B, Finlayson BA: Mathematical modelling of normal pharyngeal bolus transport: a preliminary study. J Rehab Res Dev 1998, 35:327–334.Google Scholar
- 20.Nicosia MA, Robbins JA: The fluid mechanics of bolus ejection from the oral cavity. J Biomechan 2001, 34:1537–1544. Modelling of bolus rheology explaining the balance between “fluidity” promoting turbulence and penetration risk on one hand versus viscosity demanding greater propulsive forces for clearance on the other.CrossRefGoogle Scholar
- 22.Dennis M: FOOD Trial (Feed or Ordinary Diet): a multicentre trial to evaluate various feeding policies in patients admitted to hospital with a recent stroke [abstract]. Stroke 1998, 29:551.Google Scholar
- 23.Bath PM, Bath FJ, Smithard DG: Interventions for dysphagia in acute stroke (Cochrane Review). The Cochrane Library. Oxford:Update Software, 2002:CD000323. Evidence-based review of efficacy studies.Google Scholar
- 41.Deane KH, Whurr R, Clarke CE, et al.: Non-pharmacological therapies for dysphagia in Parkinson’s disease (Cochrane review). Cochrane Database of Systematic Reviews. 2002, 2:CD002816. Evidence-based review of swallow therapy in Parkinson’s disease.Google Scholar
- 43.Williams RB, Grehan MJ, Hersch M, et al.: Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia. Gut 2003, in press. Thorough evaluation of dysphagia in a population with inflammatory myopathyGoogle Scholar