746 Exam 2 (mine)

Zenker’s Diverticulum

Pouch that forms in the wall of the pyriform sinus in upper esophagus due to muscular weakness

Zenker’s Diverticulum TX

Treat dysphagia related symptoms and consult MD for surgery

Anterior Cervical Spine Surgery

Surgery to treat stenosis/herniated discs, and weakness and numbness

Anterior Cervical Spine Surgery complications

edema and hematoma

increased complications: age, posterior fusion, degenerative spinal diseases, and combined anterior/posterior procedures

Zenker’s Diverticulum ID

Videoflouroscopy

Anterior Cervical Spine Surgery and swallowing

The larynx is displaced to access the posterior pharyngeal wall. The pharynx is then cut open to access the spinal cord

NOT CHRONIC, immediate impact

Zenker’s Diverticulum impacts on swallowing

Dysphagia and potential aspiration

Regurgitation and post swallow cough
Regurgitation and noisy swallow

Neoplasms impact on swallowing

Distort swallowing
Obstruct swallow
Reduce swallowing movement
Impair motor and sensory functions

Location of the swallowing valves that can be impacted by tumors and cause dysphagia

Lip seal
anterior tongue
posterior tongue
palate
velopharyngeal region
larynx
UES

What are post surgical complications assocated with head and neck cancers

Malnutrition, dehydration, aspiration, pneumonia

Possible surgical locations for head and neck tumors

lip surgery
floor of mouth surgery
lingual surgery
palate surgery
mandibular surgery
oropharyngeal surgery
hypopharyngeal surgery
laryngeal surgery

Tracheotomy

surgical incision into the trachea to establish an airway

Stoma

Result of laryngectomy

Different than a trach because trach is temporary

the actual hole

Reasons for a trach

tumor, trauma, edema
they need ventilator support, but they cannot stay on it forever
management of pulmonary hygiene (secretions)

Trach issues

43-83% of people aspirate

reduced laryngeal elevation
reduced glottal closure

disrupts respiratory/swallow cycle

What is a speaking valve (Passi Mirror Valve)

allows air into the trachea but does not let air out
-the exhaled air must travel around the trach tube and through the VF out the mouth of the nose

-Only use if pt can exhale around deflated cuff

Can you put a valve on someone that has an inflated cuff

NO the cuff must be deflated

and they WONT be able to breathe/talk/swallow

Speaking valve (pasi mirror valve) benefits

Voicing, sensation, cough, reduced subglottal air pressure

Clinical Swallow Exam advantages

30 mins

immediate results

repeatable

in pt’s room

utilizes current diet

Clinical Swallow Exam disadvantages

not standardized

wide variation

inadequate for complex cases

Clinical Dysphagia symptoms

pt’s feelings of food stuck in throat

Clinical Dysphagia signs

seeing it on videofluoroscopy or FEES

CN Exams

Tell you about the whole system

Unable to tell where in the system the issue is

FEES

+: able to see ANATOMY very well, no radiation, real time, no transportation, helpful to see pre and post swallowing skills, reside

-: cannot see the actual swallow as the camera turns white when the epiglottis flips over and it reflects the light, unable to see, through nose (no dementia, TBI, or cog. issues)
*give pt dyed liquid trials

Videofluroscopic swallow study (VFSS)

+: real time imagery of oral, pharyngeal, esophageal swallowing stages to determine dysphagia, some residue, shows aspiration (any population)

-: radiation, expensive, req. transportation, wait time

Eligible populations for swallowing therapy

good cognition and compliant

8-point penetration-aspiration scale

a way to describe swallowing

what can you see from VFSS

pharyngeal stripping wave
pharyngeal contraction
pharyngeal UES opening
tongue base retraction
pharyngeal residue
esophageal clearnece in upright position

Oral hygiene

Very important for health. If you are going to aspirate, do it with a clean mouth

Swallowing maneuvers (5)

supraglottic swallow
super-supraglottic swallow
effortful swallow
Mendelson maneuver
tongue hold maneuver

Autonomy

Informed Consent

Beneficence

Nonmaleficence

Justice