eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Surgical Management of Chronic Aspiration: Workup

Author: Mark E Gerber, MD, FACS, FAAP, Assistant Professor of Otolaryngology, Northwestern University, The Feinberg School of Medicine; Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem
Contributor Information and Disclosures

Updated: Feb 13, 2009

Workup

Imaging Studies

  • A modified barium swallow technique with videofluoroscopy examines upper aerodigestive function. This study is considered the criterion standard in the evaluation of swallowing function.
    • During the study, the patient swallows food and liquids of varying consistency mixed with a small amount of barium while in the fluoroscopy suite.
    • The image is adjusted to view the lips, the soft palate, the posterior pharyngeal wall, and the cervical esophagus.
  • Ultrasonography can be useful in studying the oral swallowing phase.
    • This imaging study avoids the use of radiation and allows the visualization of the actual tongue surface instead of the swallowed bolus.
    • Abnormalities of tongue movement, tongue and palate approximation, and hyoid elevation can be detected.
  • Radionuclide scintigraphy can measure the severity of aspiration.
    • To facilitate this imaging study, the patient swallows a small amount of water with technetium-99m.
    • While the patient lies under the scintillation camera with a computerized counting device, the radiologist compares the amount of radioactive material entering the lung to the total radioactive count and calculates the percentage of aspiration.

Diagnostic Procedures

  • The functional endoscopic evaluation of swallowing involves positioning a flexible nasopharyngoscope just posterior to the soft palate. This position allows for observation of the hypopharynx and the larynx, while the patient is fed various consistencies of food dyed with coloring to aid visualization. Sensory testing can be performed using a calibrated puff of air delivered to the supraglottic larynx.
    • Parameters that can be evaluated include pharyngeal pooling, premature spillage, laryngeal penetration, aspiration, and residue.
    • The benefits of this technique over the rehabilitative swallow study include the ability to assess pharyngeal sensation and the absence of radiation exposure. The disadvantages include that the test is mildly invasive. In addition, evaluation is limited to the events immediately before and after the swallow event, with the preparatory and oral phases of the swallow only indirectly evaluated and no evaluation of the esophageal phase.
  • Manometry uses a catheter passed through the pharynx into the esophagus to measure the pressure changes. When used with videofluoroscopy, this procedure can be helpful in identifying cricopharyngeal dysfunction.

More on Surgical Management of Chronic Aspiration

Overview: Surgical Management of Chronic Aspiration
Workup: Surgical Management of Chronic Aspiration
Treatment: Surgical Management of Chronic Aspiration
Follow-up: Surgical Management of Chronic Aspiration
Multimedia: Surgical Management of Chronic Aspiration
References
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References

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Further Reading

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Keywords

tracheotomy, laryngectomy, laryngeal suspension, total cricoid resection, partial cricoid resection, vocal fold medialization, laryngeal closure, tracheoesophageal diversion, laryngotracheal separation, LTS, cricopharyngeal myotomy, gastrostomy, jejunostomy, salivary output, fundoplication, airway protection, upper airway, upper aerodigestive tract, oropharynx, pharynx, larynx, phonation, respiration, swallowing

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Contributor Information and Disclosures

Author

Mark E Gerber, MD, FACS, FAAP, Assistant Professor of Otolaryngology, Northwestern University, The Feinberg School of Medicine; Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem
Mark E Gerber, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Rhinologic Society, American Society of Pediatric Otolaryngology, and Society for Ear, Nose and Throat Advances in Children
Disclosure: Nothing to disclose.

Medical Editor

John M Truelson, MD, FACS, Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas
John M Truelson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Phi Beta Kappa, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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