The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

Diagnosis and Treatment of Dysphagia and Aspiration In Tracheostomized Patients

Roxann Diez Gross, MA, CCC-SLP University of Pittsburgh, Pittsburgh, Pennsylvania

The definition of pulmonary aspiration is "penetration of material from the oropharynx into the larynx, below the level of the true vocal cords." Tracheostomized and ventilator dependent patients are at significant risk for serious complications from aspiration due to a breakdown in the function of their normal airway defense mechanisms. Aspiration can occur during any and all phases of the swallowing process. For instance, aspiration before the swallow usually occurs as a result of disorders in the oral preparatory, oral, and/or pharyngeal phases, while aspiration occurring during the swallow is usually attributed to disorders in the pharyngeal phase. Aspiration after the swallow occurs due to pharyngeal and/or esophageal phase disorders.
Dysphagia seen in tracheostomized and/or ventilator dependent patients can stem from a combination of underlying disease and the effects of tracheostomy. Dysphagia assessment procedures most often include the clinical dysphagia exam, the videofluoroscopic modified barium swallow study, and/or fiberoptic endoscopic evaluation of swallowing (FEES). Each of the evaluation techniques will be fully explained. Videotaped examples of the modified barium swallow and FEES exams will be shown.
Therapeutic interventions for the treatment of dysphagia will also be reviewed along with the physiologic processes believed to be affected by each therapeutic technique. Furthermore, current theories related to possible contributions of air and airflow in swallowing function will be introduced. Research literature in relation to all topics discussed will also be discussed.

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