Treatment of dysphagia

Early treatment has been shown to reduce the risk of aspiration pneumonitis , to reduce complications related to malnutrition and dehydration , to reduce the length of hospital stay
A ) daily tongue training - causes increase in proportion of neurons in the primary somatosensory cortex ( S1 ) and primary motor cortex ( M1 )
B ) non swallow task training to be given first to stimulate oropharyngeal gestures
C ) isometric lingual exercises
D ) expiratory muscle strength training
E ) mendelsohn and maasko manuever ( in mendelsohn there is prolonged swallowing and in maasko there is anchoring of anterior part of tongue )
F ) New - pulsed electrical stimulation is delievered in a controlled structured manner ( 59 sec on , 1 sec off for 60 continuous minutes daily for 2 weeks ) - it should only be given to patients who can overcome hypolaryngeal lowering

  • Is divided into posture , manuevers and diet modification
  • are performed with every swallow or just before swallowing - self dilatation of UES by balloon catheter and by thermal tactile stimulation
  • a chilled laryngeal mirror is to be stroked to anterior faucial pillars 5 to 6 times before a meal and intermittently throughout the meal
  • implementation of postural strategy ( use of gravity , changes in anatomy to assist propelling bolus of improving airway protection )
    A ) eg -
    1 - chin tucking to widen the vallencula
    2 - positioning the epiglottis in more protective position posteriorly to prevent aspiration
    3 - collapsing pharyngeal space by turning the patient head to impaired side
    4 - head rotation to both sides to enhance opening of UES
    5 - breath holding to improve voluntary airway closure
    6 - oral hold
    7 - bolus modification
  • By modification of food and liquid properties ( most common strategy (
    Eg -
    1 in patients who have decreased oral strength or coordination - soft solid foods such as chopped or puried
  • Surgery
    A ) UES dilatation
    B ) Cricopharyngeal myotomy
    C ) Pharyngeal bypass