Question
I have a patient with severe pharyngeal dysphagia including complete dysfunction of the cricopharyngeus muscle. He was referred to a GI doctor for dilation, but this did not help at all. The only way he can clear anything, including his own saliva, is to
Answer
In order to provide you some more specific ideas it is important that you understand why the patient has severe pharyngeal dysphagia. Some questions which might be explored include: what is the diagnosis, what is the cause of severe dysphagia as observed on the instrumental examination (motor, sensory, anatomic, combination)? is the dysphagia chronic, acute or degenerative?, is the patient able to protect his/her airway (what is their voice, cough and respiratory status), how is their cognition? Are they taking medications that might exacerbate the dysphagia?
The cricopharyngeal dysfunction can be a result of both problems at the level of the cricopharyngeal muscle (inability to relax in a timely manner), but opening of the UES is also dependent upon passive mechanical operation of hyoid bone movements anteriorly and superiorly. Therefore, sometimes CP dysfunctions are observed in cases where the muscle is relaxing as it should, but the mechanical movements that occur during the pharyngeal phase are not occurring. Finally you indicate that you have tried multiple therapy techniques, what were these techniques and what specifically were you trying to target with the techniques that you used?
Dr. Donna Scarborough has been a practicing speech-pathologist for 13 years serving populations across the lifespan. She teaches the dysphagia, trach and vent course at Miami (OH)University and serves on the ASHA Division 13 Research Committee. Dr. Scarborough can be reached at scarbod@muohio.edu
Donna Scarborough, Ph.D
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