Thursday, 2 February 2012

Food or Feed !

I had organised a workshop on swallowing difficulty i.e.dysphagia on 1st Feb.It was worth all the efforts I put in for the last one & half months.Indian Speaker Dr Jayakumar Menon's talk was taken very well by the audience.I am still getting phone calls from ENT's & Neurologists -thanking me for getting him to Bangalore.The U.S.faculty Dr Shirit Yarkony also presented her work which can be a good addition to dysphagia diagnostics & management.

As Hippocrates said
"The wise man should consider that health is the greatest of human blessings. Let food be your medicine."

As an ENT Surgeon,I come across patients with swallowing problems routinely.Swallowing is a sequential process in which food is prepared in the oral cavity then propelled into the back of the mouth & quickly it passes from the pharynx into the oesophagus.Finally from the oesophagus it reaches the stomach.The first two parts are under our control (voluntary) while the latter occurs involuntarily.



ENT Surgeons take care of oropharyngeal part of swallowing difficulty  while gastroenterologists take care of oesophageal part of swallowing disorders.
The commonest presentations ,I am seeing & diagnosing in my practice are in the folowing order:
gastro esophageal reflux disease (GERD)
stroke or progressive neurological disorders, which may impair sensitivity, muscular coordination, or render individuals unable to control or move the tongue
The presence of a tracheostomy tube, vocal cord paralysis, tumors in the mouth, throat, esophagus, or surgery in the head, neck, or esophageal areas

The assessment starts with a detailed history & clinical examination.

The diagnostic evaluation includes
Trans nasal endoscopy,FEESST & Fluoroscopy/Barium swallow.

Some pictures of FEESST(flexible endoscopic evaluation of swallowing & sensory testing)

The gold standard radiodiagnosis is fluoroscopy in which the special dye coated liquid or solid food is given to the patient & the whole process of swallowing is examined.


After the level of  swallowing problem is diagnosed -the management is planned.Most of the GERD need medical management.The neurological cases need swallowing rehabilitaion therapy.Many cases will initially need tube feeding.

Some may need tube for long term & tube is inserted into the stomach as shown

However what they get is the feeds through these tubes-nutrition is taken care of .These patients always wait to taste & eat the food through the mouth.

Just to remember 1/3rd of stroke patients are at risk of aspiration pneumonia & there still stroke patients dying of this complication all over the world.

The swallowing rehabilitaion should be started as early as possible even though patient is tube fed.Surgery has a role to play in selected few cases.

The elderly population of the world is increasing & we need to understand & learn dysphagia mechanism far better even for these normals.

What we aim for is normal eating ......

 Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity.
   ~Voltaire

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