Question
Are there any specific techniques for epiglottic dysfunction? I do not have access to electrical stimulation at this time and would appreciate some functional exercises that a high functioning patient can do. His difficulties are many: left vocal fold par
Answer
My experience is with adults with a variety of head and neck disorders. Thus I draw from this experience. You indicate a 40 y.o. with male left vocal fold paralysis and decreased epiglottic functioning with decreased laryngeal peristalsis and occasional incomplete swallows with decreased tongue driving force but not aspirating now. I would address this with concern to three areas: 1. Laryngeal function (rise), 2. Tongue movement/strengthening, and 3. Swallow technique.
With L VF paralysis, part of the epiglottis dysfunction may be due to incomplete rise in the larynx during the swallow reflex. I might suggest some treatment to address increased laryngeal rise, i.e. manual assist during swallow, pushing exercises, concentrated increased strength of swallow.
Glossal exercise should include both range of motion as well as pushing exercises, with particular attention to address increased tongue press during the swallow reflex.
Experiment with swallow modifications that will increase the strength of bolus push. I might evaluate velo-pharyngeal closure to insure that that port is getting completely sealed during the swallow. You might consider evaluating this informally by having him swallow with and without nasal occlusion.
You might want to review the past swallow evaluations to review velo-pharyngeal closure, glossal movement and coordination of the swallow reflex. Finally, I would want to review these functions on a periodic basis to insure that function is not deteriorating. If symptoms continue to deteriorate, I would want to consider a neurologic consult to rule out any of the progressive neurologic diseases.
Dennis Fuller, Ph.D., is an Associate Professor in the Departments of Communication Sciences and Disorders and Otolaryngology, Saint Louis University. He publishes in the areas of Post Surgical Communication and Swallowing disorders. He is a current Legislative Council representative from Missouri to ASHA.
Dennis Fuller, Ph.D
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