ESSD Commentary on Dysphagia Management During COVID Pandemia

Abstract

Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.

Severe oropharyngeal dysphagia following COVID‐19: a case report

“…According to the ESSD commentary, the instrumental assessment has not been previously performed because of high infection risk. 6…”

“…These issues were confirmed by FEES, which was performed after observing the patient's performance at meal for several days. According to the ESSD commentary, the instrumental assessment has not been previously performed because of high infection risk 6 …”

“…5 However, there are no data about the incidence of dysphagia in these patients also owing to the reduction of diagnostic procedures such as Fiberoptic Endoscopic Evaluation of Swallowing (FEES) during COVID-19 pandemic because of the aerosol-generating risk. 6 In May 2020 the first case report on oropharyngeal dysphagia associated with Sars-CoV-2 was published: the patient, a 70-year-old man, after an 11-day intubation developed dysphagia and a subsequent aspiration pneumonia. The instrumental evaluations evidenced bilateral absent GAG reflex, pyriform and vallecular salivary stagnation and silent aspiration.…”

“…Although COVID‐19 patients were intubated longer, they showed less swallowing disorders after extubation and required fewer re‐education sessions 5 . However, there are no data about the incidence of dysphagia in these patients also owing to the reduction of diagnostic procedures such as Fiberoptic Endoscopic Evaluation of Swallowing (FEES) during COVID‐19 pandemic because of the aerosol‐generating risk 6 . In May 2020 the first case report on oropharyngeal dysphagia associated with Sars‐CoV‐2 was published: the patient, a 70‐year‐old man, after an 11‐day intubation developed dysphagia and a subsequent aspiration pneumonia.…”

Severe oropharyngeal dysphagia following COVID-19: a case report

“…Although Covid-19 patients were intubated longer, they showed less swallowing disorders after extubation and required fewer reeducation sessions [4]. However, there is no data about the incidence of dysphagia in these patients also owing to the reduction of diagnostic procedures such as Fiberoptic Endoscopic Evaluation of Swallowing (FEES) during Covid-19 pandemic because of the aerosol generating risk [5]. In May 2020 the first case report on oropharyngeal dysphagia associated with Sars-CoV-2 was published: the patient, a 70-year-old man, after an 11-day intubation developed dysphagia and a subsequent aspiration pneumonia.…”