Dysphagia as interdisciplinary diagnostic and therapeutic problem
Journal Title: Polski Przegląd Otorynolaryngologiczny - Year 2011, Vol 0, Issue 1
Abstract
The intricate mechanism of swallowing can be divided into three phases: oral, pharyngeal, and esophageal. Causes of disruptions in the swallowing process can be divided into superior (oropharyngeal) and inferior (esophageal). Neurlologic dysphagia may be caused by a disruption in different parts of the central nervous system (supranuclear level, level of motor and sensory nuclei taking part in swallowing process, peripherial nerves level and a pathology of muscle cells and spindles) or neuromuscular and muscular disorders. Neuromuscular disorders causes are: stroke, brain tumors, brain injury, bulbar and pseudobulbar paralysis, neurodegenerative diseases (amyotrophic lateral sclerosis, multiple sclerosis), tabes dorsalis, multisystem degenerations, Parkinson’s disease, delayed dyskineses, Huntington’s disease, myasthenia and myasthenic syndromes, myopathies and peripherial neuropathies. The correct diagnosis evaluation includes history taking, physical examination with palpation and consultations (laryngological, gastrological and neurological). Radiological esophagogram, videofluoroscopy, flexible endoscopic examination, ultrasound examination, manometry, electromyography, scintigraphy and 24 hour pH monitoring are main diagnostic procedures of dysphagia. Some of the reasons for the neurologic dysphagia may be treated by surgical and pharmacological methods. Neurlologic dysphagia rehabilitation is difficult, long-lasting and often falling far short of expected results. Primary it should include neurologic cause treatment if it is possible. According to WHO International Classification of Functioning and Health in 2001 non-invasive methods of dysphagia treatment may be divided into reconstitution, compensatory and adaptive techniques. The most popular reconstitution methods are thermal stimulation or tactilethermal application techniques. Dysphagia treatment by compensatory methods consists in various techniques of swallowing and posture changes application. Adaptive techniques include dietary changes avoiding o sustenances strengthening dysphagia and adequate dietary intake.
Authors and Affiliations
Jurek Olszewski, Hanna Zielińska-Bliźniewska, Piotr Pietkiewicz
Keywords
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