Common Dysphagia Treatment Methods
by Katrina M. Jensen, Fort Worth, Texas, USA
Strengthening/Range of Motion Exercises
Following adequate evaluation, if the strength of the muscles responsible for swallowing are determined to be weak, a course of strengthening may be advised. Weakness may occur as a result of a “disuse atrophy” or a weakness that sets into the muscles after a period of not being used, or not being used to the extent they typically were.
Radiation fibrosis to the musculature is also a common cause of pharyngeal weakness in the larygectomy population. Studies have shown that more strength gains and retention of strength is made when strengthening intervention occurs as close to the time of radiation completion as possible [1].
The effectiveness of traditional strengthening exercises on muscles that have been irradiated is reported to be somewhat less than musculature that has not been exposed to radiation [2, 4]. The usefulness of neuromuscular electrical stimulation in this population is largely debated in the literature although may prove effective in many patients if properly utilized [4, 5, 6].
Intake Modifications
In many instances, compensations for the swallowing differences following surgery are what allow for the best result. Intake modifications are most commonly used as a means for treating dysphagia in the laryngectomy population as well as within the general dysphagic population [3].
Intake modifications refer to changes or alterations made in the overall intake pattern; for example: swallowing three times, taking a sip of liquid after a bite of solid food, turning the head to one side, etc. There are various intake modifications that can be successfully employed for a much better intake pattern, although adequate assessment of the swallow pattern and nature of the dysphagia is required to be helpful in these cases.
Dietary Modifications
Altering the texture of the diet is also a very typical management technique that may be used for short periods (during a recovery or interventional phase) or may be long-term depending on the nature and severity of the dysphagia [1, 3].
Medical/Surgical Intervention
In some cases, after proper identification of the nature of the dysphagia, it may be determined that the best interventions may involve further surgery or additional medical intervention. Esophageal dilation of an area of stricture or stenosis within the esophagus is a common technique used in this population although its success can vary greatly and is impacted by many factors [2]. These can be more thoroughly discussed with your physician if this becomes a viable consideration.
What is important to consider is that in many cases, a combination of interventional approaches described above can often be used to allow for the best outcomes. Adequate evaluation and identification of the nature of the dysphagia will assist in guiding clinicians to the interventions that will be most appropriate in each individual case.
Literature
1. Rosenthal, D; Lewin, J; Eisbruch, A; “Prevention and treatment of dysphagia and aspiration after chemoradiationf or head and neck cancer’; Journal of Clinical Oncology; Vol 24, No 17; pp. 2636-2643.
2. Hu, HT; Shin, JH; Kim, JH; Park, JH; Sung, KB; Song, HY; “Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer”; American Journal of Roentgenology; 2010; 1994:1131-1136
3. Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders. Austin, Texas: Pro-Ed Inc.
4. Blumenfeld L, Hahn Y, Lepage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study. Otolaryngol Head Neck Surg. Nov 2006;135(5):754-757.
5. Clark H, Lazarus C, Arvedson J, Schooling T, Frymark T. Evidence-Based Systematic Review: Effects of Neuromuscular Electrical Stimulation on Swallowing and Neural Activation. Am J Speech-Language Pathology. 2009;18(November):361- 375.
6. Kiger M, Brown CS, Watkins L. Dysphagia management: An analysis of patient outcome using VitalStim Therapy compared to traditional swallow therapy. Dysphagia. 2006(DOI: 10.1007/s00455-006-9056-1).