Samitivej Swallow Solutions Center offers treatment for dysphagia, from assessment and diagnosis through swallowing therapy, in order to avoid choking or aspiration in the elderly
Dysphagia (difficulty swallowing) is a common health problem in elderly patients, and can be a serious issue, especially for those with neurological or muscular disorders. Because of this, assessment and diagnosis are important in order to gain an accurate understanding of the problem and any related issues. In some cases, special equipment must be used in order to improve the efficiency in identifying the specific type and level of swallowing disorder. This can also help to identify any risk of choking or aspiration, especially silent aspiration, and to provide recommendations and an appropriate treatment plan. Samitivej Srinakarin Hospital provides two special tests for the diagnosis of swallowing issues—Videofluoroscopic Swallowing Study (VFSS) and Videoendoscopic Swallowing Study (VESS):
This is an examination that looks at the function, structure, and movement of the organs used for swallowing, and the causes of any swallowing disorders. The procedure involves the patient swallowing a white powder called barium sulfate, followed by X-rays to determine any abnormalities in the oral, pharyngeal, and esophageal phases of swallowing. The examination is performed in the X-ray room by a team of medical professionals that includes doctors, nurses, occupational therapists, and radiologists. During the test, a small amount of barium is mixed with foods and drinks of varying amounts, thickness, texture, and other characteristics to assess the patient’s swallowing and any physiological abnormalities, as well as to determine appropriate treatment options. In addition, certain special swallowing techniques and posture modifications may also be applied during the assessment. One limitation is that pharyngeal secretions cannot be assessed prior to swallowing.
Recommendations After Examination
A videoendoscopic swallowing study of the upper gastrointestinal tract can be carried out either in an examination room or, for inpatients, in the patient’s own hospital room. For this procedure, the doctor will use a nasolaryngoscope, which looks like a small, flexible tube with a tiny camera and light at the end of it. The nasolaryngoscope is inserted through the nose and into the esophagus and, due to its flexibility, can be adjusted to bend in the desired direction. Images recorded by the camera are displayed on a screen so that the doctor can see if there are any abnormalities in swallowing functions and/or tissue structures in the pharynx and larynx. With this test, patients do not need an X-ray, making it suitable for patients who are unable to undergo assessment using barium. This test has limitations: it cannot be used to assess the oral or esophageal phases of swallowing.
Recommendations After Examination
The patient should make sure to tell their doctor about any underlying diseases, history of drug/chemical allergies, any medications they take regularly, and surgical history, if any. The patient should get enough sleep and may need to refrain from taking certain drugs prior to the examination, depending on their individual symptoms. Some patients may need to abstain from any food or water, although this is dependent on their doctor’s advice. The patient should arrive at the hospital 30 minutes prior to their appointment in order to prepare for the procedure. Patients undergoing the videofluoroscopic swallowing study should make sure to wear clothing without any metal attached that is convenient to change in and out of.
A doctor will recommend testing by videofluoroscopic or videoendoscopic swallowing study for patients with dysphagia or with any of the following associated disorders:
After a Physical Medicine and Rehabilitation (PM&R) doctor has referred the patient to an Occupational Therapist, the Occupational Therapist will then conduct an assessment in order to make a treatment plan, adjust the patient’s diet, and recommend various techniques, including posture and positioning while eating, to help the dysphagia patient improve their quality of life.
Primary Dysphagia Treatment Guidelines