Abstract
The results of swallowing therapy in 28 patients with neurological disorders causing cricopharyngeal (CP) dysfunction are reported. Variables described include the type of swallowing disorder, type and degree of aspiration, and therapeutic strategies. Patients were monitored by cineradiography before, during, and after therapy. Success of therapy was defined by progress in type, ease and safety of feeding, and range of diet. As an example, a case of an unusually severe disorder of a CP opening subsequent to brainstem meningoencephalitis is described. The bedside clinical evaluation, otolaryngologic findings, and radiographic studies helped determine an individualized program of swallowing therapy. Therapy goals, direct and indirect therapeutic strategies, and the treatment outcome are presented. Ninety percent of patients with CP dysfunction improved with swallowing therapy, 65% by objective and 25% by subjective criteria. We conclude that in neurological patients with CP, dysfunction can effectively be treated with swallowing therapy and that surgical approaches to CP dysfunction should be deferred pending the outcome of conservative management.
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Bartolome G, Buchholz D, Hannig Ch, Neumann S, Prosiegel M, Schröter-Morasch H, Wuttge-Hannig A:Schluckstörungen bei neurologischen Erkrankungen. Stuttgart: Gustav Fischer Verlag, 1993
Neumann S: Swallowing therapy with neurologic patients—results of direct and indirect therapeutic methods allied to 66 patients suffering from neurological disorder.Dysphagia 8:149–152, 1993
Cerenko D, McConnel F, Jackson R: Quantitative assessment of pharyngeal bolus driving forces.Otolaryngol Head Neck Surg 100:57–63, 1989
McConnel FMS, Cerenko D, Mendelsohn MS: Analyse des Schluckaktes mit Hilfe der Manofluorographie.Extracta Otorhinolaryngologica 11:165–171, 1989
Logeman JA:Evaluation and Treatment of Swallowing Disorders. San Diego: College-Hill Press, 1983
Donner MW, Bosma JF, Robertson DL: Anatomy and physiology of the pharynx.Gastrointest Radiol 10:196–212, 1985
Hannig Ch, Wuttge-Hannig A: Radiologische Differential-diagnose der chronischen Aspiration.RöFo 150(3):260–267, 1989
Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brasseur JG, Hogan WJ: Opening mechanisms of the human upper esophageal sphincter.Am J Physiol 257:G748-G759, 1989
Curtis DJ, Braham SL, Karr S, Holborow GS, Worman D: Identification of unopposed muscle pair actions affecting swallowing: potential for rehabilitation.Dysphagia 3:57–64, 1988
Ekberg O: The normal movements of the hyoid bone during swallow.Invest Radiol 21:408–410, 1986
Nilsson ME, Isacsson G, Isberg A, Schiratzki H: Mobility of the upper esophageal sphincter in relation to the cervical spine: a morphologic study.Dysphagia 3:161–165, 1989
Nilsson ME, Isberg A, Schiratzki H: The location of the upper esophageal sphincter and its behavior during bolus propagation—a simultaneous cineradiographic and manometric investigation,Acta Otolaryngol 106:314–320, 1988
Dodds WJ, Man KM, Cook IJ, Kahrilas PJ, Stewart ET, Kern MK: Influence of bolus volume on swallow-induced hyoid movement in normal subjects.AJR 150:1307–1309, 1988
Kahrilas PJ, Dodds WJ, Dent J, Logeman JA, Shaker R: Upper esophageal sphincter function during deglutition.Gastroenterology 95:52–62, 1988
Ekberg O, Olsson R, Sundgren-Borgström P: Relation of bolus size and pharyngeal swallowing.Dysphagia 3:69–72, 1988
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Bartolome, G., Neumann, S. Swallowing therapy in patients with neurological disorders causing cricopharyngeal dysfunction. Dysphagia 8, 146–149 (1993). https://doi.org/10.1007/BF02266995
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DOI: https://doi.org/10.1007/BF02266995