Swallowing – Physiology, Disorders, Diagnosis and Therapy (eBook)

Dr Gauri Mankekar is a senior ENT consultant at PD Hinduja Hospital, Mumbai, India. She was the recipient of Dr Homi Modi award for research on "allergic rhinitis" and Dr Dhaygude award for best essay on "Psycho-socio conditions of youth in India".

Foreword 6
Foreword 8
Preface 10
Acknowledgments 12
Contents 14
1: Anatomy of Swallowing 15
Introduction 15
The Oral Cavity (Fig. 1.1) 15
The Oral Vestibule [1, 2] 15
The Lips 16
Oral Cavity Proper [2] 16
Boundaries 16
Cheeks 17
Hard Palate [2] 17
Soft Palate 17
Tongue 17
Innervation of the Tongue 20
Muscles of Mastication 20
Teeth and Dentition [1, 2] 20
Salivary Glands 22
Parotid Gland 22
Submandibular Gland 22
Sublingual Gland 23
Larynx 23
Laryngeal Cartilages [1, 2] 23
Ligaments [1, 2] 23
Laryngeal Muscles 23
Intrinsic Muscles [1, 2] 23
Function 24
Extrinsic Muscles [1, 2] 24
Function 24
Function 24
Laryngeal Adductor Reflex 24
Pharynx [1, 2] 25
Nasopharynx 25
Oropharynx 26
Hypopharynx 27
Circular Muscle Layer 27
Innervation of the Constrictor Muscles 27
Function 28
Longitudinal Muscle Layer 28
Innervation 28
Function 29
Esophagus [1, 2] 29
Upper Esophageal Sphincter 29
Lower Esophageal Sphincter [7] 30
Embryology and Development [2, 10] 30
Nerves Involved in Swallowing 30
Trigeminal Nerve [1, 2] 30
Facial Nerve [1, 2] 31
Glossopharyngeal Nerve [1, 2] 31
Vagus Nerve [1, 2] 32
Hypoglossal Nerve [1, 2] 32
References 33
2: Physiology of Swallowing and Esophageal Function Tests 34
Introduction 34
Oral Phase 35
Oral Preparatory Phase [1, 8] 35
Oral Propulsive Phase [1, 8] 36
Process Model of Feeding 37
Stage I Transport [1, 7] 37
Food Processing [1, 7] 37
Stage II Transport [1, 7] 37
Pharyngeal Phase 38
Esophageal Phase 39
Esophageal Function Tests 40
Introduction 40
Esophageal Manometry 41
Indications [18] 41
Contraindications 41
Equipment 41
Pre-procedure Requirements 42
Anesthesia 42
Procedure 42
Complications 43
Rare Complications 43
Interpretation 43
Flexible Endoscopic Evaluation of Swallowing (FEES) 45
Indications [22] 45
Equipment 45
Anesthesia 45
Procedure 45
Complications [22] 46
Transnasal Esophagoscopy (TNE) 46
Indications [26] 47
Esophageal 47
Extra-esophageal 47
Procedure Related 47
Contraindications 47
Relative Contraindications 47
Equipment 47
Pre-procedure Requirements 47
Anesthesia 48
Technique 48
Complications 48
Esophageal Ultrasound 48
Indications [28, 29] 49
Contraindications 49
Technique 49
Complications 50
References 50
3: Dysphagia: Clinical Diagnosis 52
Introduction 52
History 52
Physical Examination 54
General Examination 54
Local Examination 56
Other Investigations 57
Classification of Dysphagia According to the Degree of Functional Impairment 59
Conclusion 59
References 61
4: Assessment of Swallowing Disorders 62
Introduction 62
Clinical Dysphagia Assessment 63
Case History 63
Oral Mechanism Examination 63
Trial Swallows 64
Instrumental Assessments of Dysphagia 64
Modified Barium Swallow Study 65
Fiberoptic Endoscopic Examination of Swallow 68
Manometry 70
Patient Self-Assessment Tools 71
Summary 71
References 72
5: Endoscopic Diagnosis and Management of Swallowing Disorders 74
Approach to Dysphagia 74
Approach to Esophageal Swallowing Disorder 75
Zenker’s Diverticulum 75
Esophageal Diverticulum 76
Achalasia Cardia 76
Other Tests 79
Treatment 79
Diffuse Esophageal Spasm 81
Nutcracker Esophagus 82
Endoscopy in Spastic Disorders of the Esophagus 83
Management of Diffuse Esophageal Spasm and Nutcracker Esophagus 84
Scleroderma 85
Treatment 86
Gastroesophageal Reflux Disease 86
Pathophysiology 86
Investigations 86
Other Investigations 88
Treatment 88
Medical Treatment 89
Acid Suppressing Medications 89
Surgical Treatment 89
Benign Esophageal Strictures 90
Esophageal Rings 91
Esophageal Webs 92
Eosinophilic Esophagitis (EoE) 92
Lymphocytic Esophagitis 94
Infectious Esophagitis 94
Esophageal Candidiasis 94
Viral Esophagitis 95
Esophageal Tuberculosis 96
Pill Esophagitis 96
Corrosive Injury to Esophagus 96
Radiation Injury to Esophagus 98
Foreign Bodies and Food Impaction 98
Esophageal Cancer 99
Staging of Esophageal Malignancies 100
Role of Endoscopic Ultrasound (EUS) in Esophageal Malignancies 101
Role of Endoscopy in Treatment of Esophageal Malignancy 102
Extrinsic Compression of Esophagus 104
6: Radiological Diagnosis in Swallowing Disorders 105
Definition 105
Peristalsis 105
Etiology 106
Gamut of Imaging Tests Available in the Evaluation of Dysphagia [5] 109
Patient Preparation for the Radiological Examination 109
Fluoroscopic Tests 109
Videofluoroscopic Swallowing Study (VSS) 109
Barium Swallow with Esophagogram 111
CT Scan 120
Procedure [12] 121
MRI 133
Procedure 134
Conclusion 137
References 137
7: Neurogenic Dysphagia 138
Oral Preparatory Stage 139
Oral Propulsive Stage 139
Oral Stage in Eating Solid Food (Process Model of Feeding) 139
Stage I Transport 139
Food Processing 139
Movements of the Jaw, Hyoid, and Tongue or Soft Palate Over Time 140
Stage II Transport 140
Pharyngeal Stage 140
Esophageal Stage 141
Bolus Location at Swallow Initiation in Normal Swallows 141
Coordination among Eating, Swallowing, and Breathing 142
Causes of Neurogenic Dysphagia 142
Cerebral Cortex 143
Basal Ganglia 143
Cerebellum and Brain Stem 144
Peripheral Nerves and Muscles 144
Drugs and Dysphagia 144
Clinical Manifestations of Dysphagia and Pulmonary Aspiration 145
Complications of Dysphagia 145
Management 146
Dietary Modification 146
Tube Feeding 147
Swallowing Therapy 148
Surgical Treatment of Neurogenic Dysphagia 148
References 149
8: Medical Management of Swallowing Disorders 152
Introduction 152
Gastroesophageal Reflux Disease 153
Contributory or Predisposing Factors for GERD 154
Clinical Presentation of GERD 154
Diagnostic Tests 154
Treatment of GERD 155
Infectious Causes of Dysphagia 156
Etiology 156
Clinical Presentation 157
Treatment for Infective Esophagitis 158
Drug-Induced Esophageal Injury Leading to Swallowing Disorders 159
Specific Medications Associated with Esophagitis (Table 8.1) 159
Achalasia (Fig. 8.5) 160
Clinical Features 161
Investigations 161
Treatment for Achalasia (Table 8.2) 162
Eosinophilic Esophagitis (Fig. 8.6) 163
Medical Therapy 164
Diffuse Esophageal Spasm 165
Nutcracker Esophagus (Fig. 8.7) 165
Acquired Swallowing Disorders 165
Post-intensive Care/Extubation 165
Swallowing Disorders Due to Musculoskeletal Diseases 167
Summary 168
References 169
9: Pediatric Dysphagia 172
Introduction 172
Etiology and Pathophysiology in Pediatric Dysphagia 173
Normal Feeding and Swallowing Development 177
Prenatal Period 178
Postnatal Period: Infancy to 6 Months 178
Six Months to 3 Years of Life 180
Significant Considerations 181
Assessment Approaches 181
Clinical Dysphagia Assessment 181
Screening Models 182
The Clinical Dysphagia Evaluation 182
Instrumental Assessments 183
Oropharyngeal Dysphagia 183
Esophageal Dysphagia 185
Team Approaches to Dysphagia Evaluation 186
Treatment in Pediatric Dysphagia 186
Treatment Teams 186
Compensatory Interventions 187
Positioning 187
Food Viscosity and Texture 187
Specialized Equipment for Feeding 188
Rehabilitative Interventions 188
Pediatric Habilitation and Rehabilitation 189
Therapeutic Strategies 189
Transition from Tube to Oral Feeding 189
Behavioral Modification Strategies 190
Motor Learning for Functional Skills 190
Long-Term Outcomes 190
Summary 190
References 191
10: Presbyphagia 200
Introduction 200
Normal Swallowing in the Healthy Young Adult 201
Physiology of Swallowing in Older People 203
Oral Health Status 204
Dentition and Loss of Alveolar Bone 204
Tongue 204
Masticatory Performance 205
Salivation 205
Taste 206
Weak Oral Movement 206
Sensory Changes 206
Pharyngeal Abnormalities 207
Esophageal Motility 207
Upper Esophageal Sphincter Function 207
Dysphagia in Older People 209
Dementia 213
Chronic Obstructive Pulmonary Disease 214
Cricopharyngeal Dysfunction 214
Medication 214
Environment and Swallowing Disorders in Older People 215
Dysphagia Assessment 216
Dysphagia Management (Table 10.1) 221
Clinical Cases 225
Consent 228
Bibliography 228