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Pt was seen in wheelchair. Pt’s daughter and primary SLP were present for the exam. Pt c/o pain w/ swallowing at times, pills getting stuck and coughing/choking with po intake. Endoscope was inserted via R naris without difficulty. Pt demonstrated a pharyngeal swallow that was within functional age-related limits. No laryngeal penetration or aspiration was observed. The use of straws did not appear to negatively impact swallow function. No significant pharyngeal residue was present after the swallow. Oral prep was slightly prolonged, which was likely due to limited dentition and partial dentures not in place. Liquid rinsing was required to clear solids (crackers) from oral cavity. A trace amount of whitish coating was present in pharynx at baseline, some of which cleared with po intake. Per pt’s daughter, pt ate yogurt prior to FEES. Belching was noted frequently during this exam with a trace amount of backflow noted x 1 with NTL. Laryngeal edema was noted as well, which may be suggestive of laryngopharyngeal reflux (LPR). Also, a slight bulge was present at posterior pharyngeal wall. Of note, pt coughed toward the end of the exam, which did not appear to by in relation to laryngeal penetration or aspiration. Given dementia diagnosis, swallow function may fluctuate with mental status/level of alertness.
Diet: Mechanical Soft w/ Thin Liquid
1. Sit upright with all intake. Remain upright for 20-30 minutes after intake.
2. Frequent oral care to minimize risk of aspiration pneumonia.
3. Consider reflux management.