Clinical Management of Swallowing Disorders

Thomas Murry, PhD, CCC-SLP, is a Professor of the Voice and Swallowing Center in the Department of Otolaryngology—Head and Neck Surgery at the Loma Linda Health University, and Adjunct Professor in the Department of Otolaryngology—Head and Neck Surgery at Drexel University College of Medicine. Dr. Murry received the Honors of the American Speech-Language-Hearing Association in 2010, the highest honor of the association, and also received a Presidential Citation from the American Laryngological Association. Dr. Murry is recognized throughout the world for his clinical, education, and research contributions to voice and swallowing disorders. He has authored over 150 peer-reviewed publications in national and international journals. Dr. Murry has presented over 600 lectures at national meetings and in meetings in more than 35 countries. He has championed the need for combined management of voice and swallowing disorders among otolaryngologists, pulmonologists, and other medical professions. Karen Chan, PhD, is an Associate Professor and Director of the Swallowing Research Laboratory at The University of Hong Kong. She received her speech-language pathology training and PhD from The University of Hong Kong. Dr. Chan is an experienced clinician and researcher in the areas of voice and swallowing disorders. Her early research focuses on perceptual voice evaluation and voice training for professional voice users. Dr. Chan’s current research interests are in assessment and treatment of motor speech disorders and swallowing problems in elderly, poststroke individuals, and head and neck cancer survivors. Erin Walsh, MA, CCC-SLP, IBCLC, BCS-S, is a senior clinician at the University of California San Diego Health’s Center for Airway, Voice and Swallowing in the Department of Otolaryngology. She has expertise managing a wide array of complex pediatric and adult dysphagia. Her dual certification as a lactation consultant offers a nuanced perspective for neonatal feeding care. Walsh’s research focuses on objective quantification of infant suckling patterns to improve precision of breastfeeding interventions. She collaborates with engineers to develop machine learning patterns that detect anomalies inhibiting successful latching. Her work in dysphonia is uniquely suited for professional performers as she has a background in singing. Walsh additionally collaborates with gastroenterology motility colleagues spearheading novel cognitive-affective interventions for laryngopharyngeal symptoms with and without pathologic reflux.

Preface
Acknowledgments
Video List

Chapter 1. Introduction to and Epidemiology of Swallowing Disorders
Introduction
Need for Early Intervention
Epidemiology
Biomedical Ethics: Principles and Practices
Summary
Discussion Questions
Study Questions
References

Chapter 2. Anatomy and Physiology of the Swallowing Mechanism
Introduction
Central Nervous System
Peripheral Nervous System
Anatomy of the Swallowing Mechanism
The Normal Swallow
Cranial Nerves Involved in Swallowing
Sphincters
Central Neural Control of Swallowing
Respiration and Deglutition
Summary
Discussion Questions
Study Questions
References

Chapter 3. Swallowing Disorders Arising From Neurological Disorders and Other Diseases
Introduction
Neurological Disorders
Swallowing Disorders Found in Critical Care Patients
Esophageal Swallowing Disorders
Infectious Diseases
Medications and Swallowing Disorders
Autoimmune Disorders and Diseases
Anterior Cervical Spine Disorders
Summary
Discussion Questions
Study Questions
References

Chapter 4. Swallowing Disorders Following Surgical Treatments of Head and Neck
Introduction
Neoplasms
Head and Neck Surgery
Laryngeal Surgery
Skull Base Surgery
Tracheotomy
Swallowing Disorders Following Radiation Therapy
Zenker Diverticulum
Summary
Discussion Questions
Study Questions
References

Chapter 5. Clinical Evaluation of Swallowing Disorders
Introduction
Evidence-Based Practice
Multidisciplinary Dysphagia Team
Swallowing Screening
Clinical Swallow Evaluation
Self-Assessments
Related Self-Assessments to Dysphagia
Summary
Discussion Questions
Study Questions
References

Chapter 6. Instrumental Evaluation of Swallowing Disorders
Introduction
Flexible Endoscopic Evaluation of Swallowing
Modified Barium Swallow
Modified Barium Swallow, Flexible Endoscopic Evaluation of Swallowing, and Silent Aspiration
Manometry and High-Resolution Manometry
Tongue Pressure/Strength Measurement
Other Instrumental Tests Associated With Swallowing Disorders
Summary
Discussion Questions
Study Questions
References

Chapter 7. Treatment of Swallowing Disorders
Introduction
Evidence-Based Practice
Multidisciplinary Approach to Swallowing Therapy
Oral Hygiene
Compensatory Swallowing Therapy
Rehabilitative Swallowing Therapy
Prophylactic Swallowing Therapy for Head and Neck Cancer Survivors
Other Swallowing Treatment Methods
Summary
Discussion Questions
Study Questions
References

Chapter 8. Nutrition and Diets
Introduction
Dietitian and Dysphagia
Properties of Liquids and Foods
Oral Nutrition and Dysphagia Diets
Nonoral Diets
Malnutrition and Dehydration
Summary
Discussion Questions
Study Questions
References

Chapter 9. Swallowing in the Aging Population
Introduction
Aging Process Related to Swallowing
Changes in Swallowing
Nutrition in the Aging Population
Dementia
Feeding Assistance
Ethical Considerations
Summary
Discussion Question
Study Questions
References

Chapter 10. Early Feeding: A Collaborative Approach to Optimize Human Milk Intake
Introduction
Multidisciplinary Care Team
Lactation
Prematurity
Family Goals for Feeding
Caring for Diverse Families
Weaning
Cross-Disciplinary Educational Opportunities
Summary
Discussion Questions
Study Questions
References

Chapter 11. Pediatric Dysphagia: Assessment of Disorders of Swallowing and Feeding
Introduction
Etiologies
Epidemiology
Feeding Versus Swallowing
Prematurity
Milk to Solids
Taking a Case History
Intellectual Development
Summary
Discussion Questions
Study Questions
References

Chapter 12. Treatment of Feeding and Swallowing Disorders in Infants and Children
Introduction
Swallowing Phases
Collaborative Goal Setting
Growth Faltering
Nonoral Feeding
Case Illustrations Within Diagnoses
Support for Families
Summary
Discussion Questions
Study Questions
References

Chapter 13. Case Studies
Introduction
Diagnosis
Instrumentation
Personnel
Facilities
Case Studies From Voice and Swallowing Centers
Summary
Discussion Questions
Study Questions
References

Glossary
Appendix 1. Reflux Symptom Index (RSI)
Appendix 2. Reflux Finding Score (RFS)
Appendix 3. Burke Dysphagia Screening Test
Appendix 4. The MD Anderson Dysphagia Inventory
Appendix 5. Eating Assessment Tool (EAT-10)
Appendix 6. Dysphagia Handicap Index (DHI)
Appendix 7. Voice Handicap Index-10 (VHI-10)
Appendix 8. Clinical Swallowing Examination Sample Form
Answers to Study Questions
Index