Medical history: 57 year-old male w/ COPD, head and neck CA s/p chemo tx/radiation tx/surgery, dysphagia, alcohol and tobacco use, CHF, HTN, protein calorie malnutrition

Current diet:  NPO/PEG; NTL for pleasure

HINTS

Watch the video, then open the VIEW HINTS tab to see any available hints prior to viewing the results.

HINTS: 

Notice how thick the epiglottis is? This may be due to radiation tx.

VIEW RESULTS 

Open the VIEW RESULTS tab below after making your own interpretation.

Summary: 

Patient-4-Summary

 

Pt was seen sitting up in wheelchair. Primary SLP was present for exam. Pt demonstrated a mild pharyngeal dysphagia c/b: reduced BOT retraction and somewhat decreased epiglottic ROM resulting in brief pooling before the swallow with mixed consistency and trace vallecular residue after the swallow with solids. Material was present in valleculae at baseline. Suspect pharyngeal sensation may be reduced, as pt did not attempt to reflexively clear residual. Liquid rinsing effectively cleared pharyngeal residue. No laryngeal penetration or aspiration was observed during this exam. The use of straws did not appear to negatively impact swallow function. Some coughing and throat clearing was observed, which did not appear to be related to prandial penetration/aspiration, seeming more of a response to the presence of the endoscope. Endoscopic findings included larygneal edema, epiglottic edema and reduced velopharyngeal competence w/ phonatatory tasks. Glottic closure appeared intact for phonation, coughing, throat clearing and swallowing. Mastication was prolonged, which was likely due to lack of dentition and reported xerostomia.

Recommendations:
Diet:  Moistened Mechanical Soft Diet/ Thin Liquids
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. Moisten mechanical soft items with gravy, sauce, etc as appropriate.
4. Ongoing ST to monitor diet tolerance. If mastication is too difficult w/ moist mechanical soft, downgrade to pureed diet w/ thin liquids.

Download ASHA CEU Participant Form