Medical history: 95 male w/ CKD, A-fib, vascular dementia, GERD, and pneumonia.

Current diet:  Regular/Thin Liquids

HINTS

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

HINTS: 

Notice the hyoid intermittently poking through the lateral pharyngeal wall? This is a sign of lateral pharyngal wall atrophy.

Laryngeal penetration occurred during the swallow at 1:16 and laryngeal penetration occurred before the swallow at 5:24.

Backflow from UES was noted at 2:46 (with laryngeal penetration),3:38, and 4:22.

VIEW RESULTS 

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Summary: 

Patient-5-Summary

 

Pt was seen in wheelchair. SLP was present for exam. Pt demonstrated a mild oropharyngeal dysphagia c/b: reduced oral strength, reduced/mistimed BOT retraction, and decreased laryngeal elevation/epiglottic ROM which resulted in somewhat prolonged oral prep with solids, brief pooling before the swallow with mixed and solids, and laryngeal penetration before the swallow with thins and NTL, which stripped out with swallowing. No aspiration was observed during this exam. The use of straws did not appear to negatively impact swallow function. No significant pharyngeal residue was present after the swallow, other than trace, inconsistent pooling after the swallow at UES, which cleared with subsequent swallowing. Belching and backflow form UES was observed frequently during this exam. Backflowed material intermittently entered laryngeal vestibule, which pt cleared with reflexive throat clear or subsequent swallowing, thus laryngeal sensation appeared to be intact. Laryngeal edema was also noted, which in addition to observed backflow from UES, may be suggestive of laryngopharyngeal reflux (LPR) and/or an esophageal dysphagia. Also, mild atrophy of the lateral pharyngeal walls was observed. During phonation, ventricular fold hyper-function was observed.

Recommendations:
Diet:  Regular/Thins
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 GI work up to r/o esophageal dysphagia.
4. Ongoing ST to monitor diet tolerance.