Surgical Management of Chronic Aspiration Workup

  • Author: Mark E Gerber, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 1, 2012
 

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.
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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. See the images below. Type I laryngeal cleft with posterior penetration Type I laryngeal cleft with posterior penetration during functional endoscopic evaluation of swallowing (FEES). Type II laryngeal cleft. Note the abnormally posteType II laryngeal cleft. Note the abnormally posterior position of the endotracheal tube in the glottis.
    • 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.
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Contributor Information and Disclosures
Author

Mark E Gerber, MD, FACS, FAAP  Clinical Assistant Professor of Otolaryngology, University of Chicago, Pritzker School of Medicine; Division Head of Otolaryngology-Head and Neck Surgery, Section Head of Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University Health System

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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: Revent Medical Honoraria Review panel membership; Synthes Nursing Education Honoraria Other

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 of Otolaryngology, Dentistry, and Engineering, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Type II laryngeal cleft. Note the abnormally posterior position of the endotracheal tube in the glottis.
Type I laryngeal cleft with posterior penetration during functional endoscopic evaluation of swallowing (FEES).
Base of tongue thyroglossal duct cyst in infant presenting with dysphagia and aspiration without associated stridor or airway obstruction.
 
 
 
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