Physiological Characteristics of Dysphagia Following Thermal Burn Injury

Abstract

1 This project was supported by funding from the Royal Brisbane and Women's Hospital (RBWH) Foundation. 2 Physiological characteristics of dysphagia following thermal burn injury 3 AbstractThe study aim was to document the acute physiological characteristics of the swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and a fiberoptic evaluation of swallowing (FEES). Subsequent to this assessment, FEES confirmed 6 individuals (32%) had no aspiration risk, and were excluded from further analyses. Of the remaining 13, CSE confirmed two had specific oral phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal phase deficits with major finding evident in greater than 50% being: impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 60% (n = 6/10 penetration/aspiration events) of cases. Most events occurred post swallow. Findings support that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral stage swallow function. This study has identified a range of factors which may be contributing to both oral and pharyngeal stage dysfunction in this clinical population and highlights the 4 importance of using a combination of clinical and instrumental assessment to fully understand the influence of burn injury on oral intake and swallowing.

Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: Physiological characteristics and functional outcomes

“…Reduced pharyngeal and laryngeal sensation has been found to be a common feature in the thermal burns population with prior research reporting that 77% of cases in a cohort study had minimal or no response to contact of the scope to the hyopharyngeal structures during FEES (Rumbach et al, 2012b). Silent aspiration, as evidenced by the cases presented here, may be a possible outcome (Rumbach et al, 2009b;Rumbach et al, 2012b). The ability to use repeated FEES assessments to follow changes to swallowing physiology over the recovery period revealed that these sensory deficits improved greatly over the two-week period between the initial and repeat FEES in both cases.…”

“…Rumbach and colleagues (2012b) reported on 13 patients with dysphagia after thermal burn injury using fiberoptic endoscopic evaluation of swallowing (FEES) conducted at an average of one month (range = 5-80 days) post injury. FEES assessment confirmed numerous pharyngeal phase deficits, with impaired secretion management, laryngotracheal oedema, delayed swallow initiation, impaired sensation, inadequate movement of hypophyaryngeal and laryngeal structures, and the presence of diffuse pharyngeal residue being evident in greater than 50% of the cohort (Rumbach et al, 2012b). Penetration and aspiration was also found to be prevalent (83% of thin fluid trials), with penetration/aspiration being silent in 50% of cases (Rumbach et al, 2012b).…”

“…Of the 49 patients whom where clinically determined to have dysphagia, 19 patients underwent FEES (Rumbach et al, 2012b), with only two meeting the criteria of having repeat FEES.…”

“…Both the CSE and FEES were carried out as per the protocol outlined in Rumbach et al (2012b). It is important to note that independent use of FEES by SLPs is not authorised in this facility.…”

“…In the few studies that have included data from instrumental assessments (Edelman et al, 2008;Muehlberger et al,. 1998;Rumbach et al, 2009a;Rumbach et al, 2011b;Rumbach et al, 2012b), results have been reported as part of the initial case presentation and only then repeated occasionally during the course of recovery. To date, no studies have systematically documented the pattern of swallow recovery with a combination of clinical and instrumental swallowing assessment.…”