Therapeutic aspects of oral and pharyngeal swallowing dysfunction. Videoradiographic and videomanometric analyses of adult healthy volunteers and dysphagic patients

Abstract: In this study simultaneous videoradiography and intraluminal manometry (videomanometry) have been used in combination in three studies to analyze how different therapeutic strategies affect the physiology of swallowing in healthy volunteers and in patients with pharyngeal dysfunction. Analyses of healthy volunteers showed few significant measurable effects on the pharyngeal swallow. Some decreased movements of anatomical structures and some differences in intraluminal pressure were found. In patients with pharyngeal dysfunction the major findings concerned the radiological variables. The depth of contrast penetration into the larynx and the trachea was significantly reduced, but the techniques did not reduce the number of misdirected swallows. The intrabolus pressure when measured at the level of the inferior pharyngeal constrictor did not alter when the three techniques were performed. Videoradiography was used in three other studies to evaluate how different therapeutic strategies affect the physiology of swallowing, and nutritional parameters in dysphagic patients. Survival times and therapeutic recommendations were compared in two groups of dysphagic patients, one group with an absent pharyngeal swallow (APS) and one group with a pharyngeal swallow (WPS). When dysphagic patients who aspirated on thin liquids were given carbonated liquids they had a significantly reduced penetration/aspiration, pharyngeal transit time and pharyngeal retention compared to both thin liquids and thickened liquids. An association between dysphagic treatment and improved nutritional conditions was found. APS is associated with high mortality. When APS and WPS were compared it was found that the majority of APS patients who died, did so within a short period of time after entering the study. In the WPS group most patients died after 12 months. The APS group were recommended no oral intake and the WPS group oral nutrition together with diet modification and different therapeutic strategies. Conclusion: Results from some of these studies contribute new knowledge applicable to the treatment of dysphagic patients, thereby improving management routines. Dysphagic patients must be individually evaluated. The dysfunction must be defined according to its etiology. However, it is the pathophysiology that guides the choice of swallowing management.