Profiling of Oropharyngeal Dysphagia in an Acute Care Hospital Setting

Abstract

Purpose: To identify the main complaints, diagnostic tools, as well as the treatment plan in patients presenting with oropharyngeal dysphagia in the acute care settings. Methods: The electronic medical chart of 100 consecutive hospitalized patients who presented an oropharyngeal dysphagia were retrospectively reviewed from January 2017 to January 2019. Results: The mean age of patients was 76.03 (standard deviation = 16.06) years old with 71% of patients being males. The most common admission diagnosis was pneumonia (30%), followed by stroke (28%). The swallowing evaluation was performed on the regular floor in 85% of patients and in the intensive care unit in 15% of patients. The main reasons for the swallowing evaluation are suspicion of aspiration by the medical or nursing teams (60%), systematic evaluation (20%), ear, nose and throat (ENT) complaints by the patient (14%), and aspiration pneumonia (6%). Fiberoptic endoscopic evaluation of swallowing with sensitivity testing was the most common diagnostic tool used alone in 88% of patients. Diet and postural modifications were prescribed to 71% and 62% of the patients, respectively. Swallowing exercises were performed in 43% of patients. Overall, otolaryngologist interventions resulted in an increased rate of patients getting oral intake compared to nonoral feeding routes ( P = .05). Conclusions: This study adds knowledge about the causes and characteristics of oropharyngeal dysphagia in an acute tertiary medical setting. It also provides insights regarding the role, and the consequences of a swallowing intervention led by an ENT specialist in collaboration with the members of the health team.

Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

“…among different age groups has previously been described in the literature, and age is known to be a major risk factor in the development of the condition. 12,22 The aging process affects both the oral and oropharyngeal phases of swallowing, even in people without comorbidities. The disruption of both the mechanisms of bolus propulsion and upper airway protection can increase age-related dysphagia.…”

“…These findings are supported by previously published evidence in similar settings. 5,22 Given the natural history of the disease, there is a high probability of dysphagia inducing aspiration pneumonitis, which could evolve into pneumonia in older or immunocompromized patients. 12,24 The distribution of patients with dysphagia among the different departments at discharge showed how that it is a highly transversal process.…”

Evolução funcional da deglutição em pacientes com COVID-19 internados em UTI

“…Recent studies indicate that these patients may present damage to the central and peripheral nervous system as a direct result of the virus or due to the innate and adaptive immune response to infection (3) . Patients, whether due to prolonged intubation or neurological damage, are at high risk of oropharyngeal dysphagia (4)(5)(6)(7)(8) .…”

Disfagia orofaríngea, náuseas y vómito crónicos, terapias alternativas y complementarias en trastornos de la interacción intestino-cerebro... en los tiempos del coronavirus

“…Incluso, recientemente, la disfagia orofaríngea se ha asociado con alteraciones motoras periféricas 2 . El artículo inicia con una definición de la disfagia orofaríngea con un enfoque al tratamiento a las alteraciones de la fase oral y la fase faríngea haciendo hincapié en que la terapéutica va dirigida a mantener el estado nutricional y de hidratación del paciente, así como a prevenir las infecciones respiratorias y la neumonía por aspiración 1,3 . En general, el tratamiento tiene cuatro avenidas, incluyendo la parte nutricional mediante modificación de la consistencia y textura de los alimentos; la rehabilitación por medio de ejercicios de deglución; técnicas de neuroestimulación; dilatación del esfínter esofágico superior mediante toxina botulínica, dilatación con balón o miotomía; y la alimentación mediante sonda nasoenteral o gastrostomía, así como la indicación de cada una.…”