Dysphagia following total laryngectomy: a myth or a reality? How can we help

<p class="Default">Total laryngectomy leads to drastic anatomical changes in the swallowing and breathing mechanism. Reduced tongue base retraction, poor pharyngeal clearance, stricture and prominence in the posterior pharyngeal wall have been reported to cause swallowing difficulties in individuals with total laryngectomy. The present case study describes the swallowing characteristics in an individual with total laryngectomy and discusses efficacy of swallowing maneuvers in total laryngectomy. A 55 yr/male, operated case of total laryngectomy using TEP reported with complaint of food getting stuck in the throat and vomiting sensation. He was fed orally and could tolerate only thick liquids. Swallowing assessment was carried out by clinical and instrumental tools (modified barium swallow) which revealed cricopharyngeal prominence, poor pharyngeal clearance and significant post swallow residue. Effortful swallow was attempted to explore the change in swallowing mechanism. Relaxation of pharyngeal wall with better pharyngeal clearance was seen with the maneuver. Clinically, the case reported of ability to swallow semisolids and solids well with the maneuver. At 3 month follow up, the case reported no difficulty in swallowing semisolids and solids orally. The above case study highlights on radiological evidence of swallowing abnormalities following total laryngectomy and further on the efficacy of maneuver on mechanism of swallowing. Hence, it can be noted that swallowing intervention has strong implications in patients with total laryngectomy. </p>

INFLUENCE OF AGE ON SWALLOWS OF A HIGHLY VISCOUS LIQUID BOLUS

Background Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. Objectives Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. Methods We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women) aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women) aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm3, and viscosity of 895 cp. Results The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. Conclusions On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old) than in younger subjects (19-55 years old), which suggested an adaptation to the aging process to maintain a safe swallow.