Medical history: 61 year-old female s/p R subtotal parotidectomy w/ facial nerve perservation and R neck dissection, s/p trach, and s/p XRT.

Current diet:  NPO/PEG

HINTS

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HINTS: 

Laryngeal penetration occurred throughout the exam (0:40, 2:08, 3:21, 4:20, 4:45, and 5:16)

VIEW RESULTS 

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Summary: 

 

Patient-6-Summary

Pt was seen in chair. Primary SLP was present for exam. Pt was recently decannulated. Pt with hoarse and intermittently wet vocal quality.  Pt demonstrated a severe pharyngeal dysphagia. Thick, whitish and yellow secretions were noted in pharynx and laryngeal vestibule at baseline, which pt was unable to fully clear with cued throat clear and swallowing. Once po’s were introduced, secretions were eventually cleared from pharynx and larynx. Laryngeal anatomy appeared to have been altered by surgery and radiation tx, including edema/erythema, minimal arytenoid movement, and a partial epiglottis with irregular edges. View of TVCs was limited by ventricular fold edema/erythema. Ventricular fold hyperfunction was observed with phonation and decreased TVC closure was suspected. Reduced lateral pharyngeal wall movement was observed, which appeared to be most significant on L side. Reduced hyolaryngeal elevation/epiglottic inversion led to laryngeal penetration before and during the swallow with thin and NTL with subsequent aspiration. Delayed reflexive coughing occurred with aspiration. Reduced pharyngeal constriction (R>L) contributed to significant residue and was present after the swallow with NTL, which required thin liquid rinsing to clear. Did not test thicker consistencies due to the significant amount of residual present w/ NTL. Less penetration/aspiration occurred with thins than NTL and pt was more successful in clearing thins from laryngeal vestibule. Also, significantly less pharyngeal residue was present after the swallow with thins than with NTL. Additionally, thins helped to clear pharyngeal and laryngeal secretions. Therefore, recommend allowing unthickened water for comfort/hydration after aggressive/thorough oral care. Recommend repeat FEES after working on airway protection, in addition to effortful swallow. Also, consider training supraglottic swallow maneuver to attempt on repeat exam.

Recommendations:
Diet:  NPO except thin water after oral care when sitting upright.
1. Intensive dysphagia tx w/ SLP.
2. Repeat FEES prior to advancing diet.