The Role of Imaging Modalities in Diagnosing Dysphagia: A Clinical Review. In such cases, the material commonly pools in the vallecula and pyriform sinuses. Adult acute epiglottitis is a rare but life-threatening disease caused by obstruction of the airway. found an association between the presence of vallecular pooling and aspiration in patients with HNC [13]. Or this individual might be advised to avoid composite foods, since his or her swallowing deficiency could make it harder to stay organized with several consistencies in the mouth at once. The body of the esophagus may be obstructed by a web, stricture or tumor. The lingual tonsils constitute the Waldeyer ring along with the palatine tonsils, adenoids, tubal tonsils, and lateral pharyngeal bands. Ready for a unique experience? This content is owned by the AAFP. Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality and represents a substantial economic and social burden throughout the world [].It is the fourth-leading cause of death in the United States and Europe and the burden of COPD is likely to worsen as the population continues to age [].In Brazil, COPD is the third-leading cause of death, having . These depressions serve as spit traps; saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The physical examination should include the neck, mouth, oropharynx and larynx, and a neurologic examination should also be performed. This finding may be explained by the greater distance between the valleculae and laryngeal vestibule, compared to the anatomic position of the pyriform sinuses relative to the laryngeal vestibule [25]. This outcome is not what would be expected in clinical practice, and no clear explanation was found for it. Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: a systematic methodological review. Abnormal swallowing, or inability to swallow. The laryngeal vestibule due to premature what happens if the valleculae overflow before swallowing occurs spillage the pharyngeal stage of swallowing due. What causes pooling in the vallecula? Swallowing disorders are especially common in the elderly. In this population, OD can be a result of the disease itself or its treatment. Liou HH, Hsieh MH, Tsai SH, Hung DS, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. Dysphagia. Logistic regression analyses with correction for the location of pooling, tumor stage, tumor location, and cancer treatment were performed to explore the association between pooling and . It has also been suggested that the presence of aspiration in HNC patients is affected by the type of cancer treatment (surgery, chemotherapy, or radiotherapy), rather than by tumor location [13]. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. A few other common causes include: A tear in a salivary gland: A bump or injury could cause swelling or inflammation to the salivary. These include: Streptococcus pneumoniae (pneumococcus). The upper esophageal sphincter relaxes during the pharyngeal phase of swallowing and is pulled open by the forward movement of the hyoid bone and larynx.3 This sphincter closes after passage of the food, and the pharyngeal structures then return to reference position (Figure 3). There is a mucosa-covered mass (marked with lines) between the posterior pharyngeal wall (longer dashed line) and the arytenoid towers ( marked with A). The patient swallowed a bolus of blue-stained applesauce to verify basic (though abnormal) capability. The protocol included a clinical ear, nose, and throat examination comprising integrity of cranial nerves performed by a laryngologist, the Functional Oral Intake Scale (FOIS) [7], and a standardized FEES examination [18]. In a nonclinical setting, multiple factors may affect the swallowing mechanism such as fatigue, increased complexity of feeding in terms of various bolus consistencies, and diverse eating behaviors and postures. For each visuoperceptual ordinal FEES variable, the inter- and intraobserver agreement levels were calculated using linear weighted Kappa coefficient [24]. Sorina R. Simon. Correspondence to This photo follows 4 additional boluses delivered in a rapid, pressured fashion, intentionally seeking the patients limits.Note pooled blue applesauce, but without soiling of the laryngeal vestibule. Ninety dysphagic HNC patients underwent a standardized fiberoptic endoscopic evaluation of swallowing (FEES) using thin and thick liquid boluses. eCollection 2021 Jul. In contrast, other studies could not demonstrate a significant relation between either tumor stage [35], tumor location [4, 13], or cancer treatment [4] on the one hand, and aspiration on the other hand. Patients characteristics including TNM classification, tumor location, oncologic treatment, and FOIS score are presented in Table1. Indeed, aspiration pneumonia is a common cause of death in hospitalized patients. what is the recommended ratio for lifeguard to swimmer What causes pooling in the vallecula? Odynophagia is the medical term for painful swallowing. Disable Fast Startup feature and see. Thus, pyriform sinus pooling in HNC patients is not only a marker of impaired swallow efficiency but was also associated with impaired swallow safety (aspiration). Normal aging has subtle effects on all four stages of swallowing, but the clinical significance of these effects is uncertain.1,6. Although not a swallowing disorder per se, gastroesophageal reflux disease (GERD) is a closely related problem.9 Patients with GERD are at risk for reflux esophagitis. Although rare, vallecular cysts should be considered in the workup of dysphagia. The epiglottic vallecula consists of a small mucosa lined depression (vallecula) located at the base of the tongue just between the folds of the throat on either side of the median glossoepiglottic fold. Yet there is only limited literature regarding the possible association between postswallow pharyngeal pooling and aspiration in patients with HNC. Despite having swallowed several boluses of blue applesauce and water, the laryngeal vestibule shows no soiling, explaining why the patient is managing her swallowing even though she is aware that it is abnormal. In the fiberoptic endoscopic examination of swallowing (FEES), a transnasal laryngoscope is used to assess pharyngeal swallowing.23 Because pharyngeal contraction obstructs the lumen, the FEES does not show the motion of essential foodway structures or the food bolus during the swallow. Nasopharynx: It is situated in the space between the back of the nose and soft palate. Factors associated with aspiration are advanced age and tumor stage, previous history of head and neck surgery, and/or chemotherapy [13]. The aryepiglottic folds extend between the arytenoid cartilage and the lateral margin of the epiglottis on each side and constitute the lateral borders of the laryngeal inlet. https://doi.org/10.1007/s00455-013-9459-8. However, the present sample size was too small to allow statistical pooling. Due to the limited number of events (aspiration) and nonevents (no aspiration), it was not possible to adjust for all three factors simultaneously, and thus, these factors were included in the analysis separately. Maintaining oral feeding often requires compensatory techniques to reduce aspiration or improve pharyngeal clearance.1,19. However, it can identify aspiration and pharyngeal retention after the swallow. Mild-to-moderate pyriform sinus pooling compared to no pooling was not significantly associated with aspiration (OR 4.25, 95% CI 0.87, 20.75, p=0.074) (Table3). Similar results were seen after correction for pooling in the other location, and after additional correction for tumor stage, tumor location, or type of cancer treatment. Each vallecula is bordered medially by the median glossoepiglottic fold and laterally by the lateral glossoepiglottic fold. Blockage of the laryngeal inlet causing severe respiratory distress is an unusual presentation. Based on our results, we assumed that patients presenting severe pyriform sinus pooling of thick liquid are more likely to present aspiration, compared to patients who do not present pooling in the pyriform sinuses. It is usually not seen by the naked eye as it is far back and deep at the root of the tongue. Is. You can't see it during a bedside evaluation! Prevention. Similarly, swallowing is generally the best therapy for swallowing disorders. Epub 2015 Oct 9. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. This variable was rated as present or absent. 2013 Dec;28(4):494-500. doi: 10.1007/s00455-013-9459-8. Pharynx (51.1%) and larynx (26.1%) were the most common tumor sites. what causes pooling in the vallecula. Despite having swallowed several boluses of blue applesauce and water, the laryngeal vestibule shows no soiling, explaining why the patient is managing her swallowing even though she is aware that it is abnormal. This association was independent of the presence of vallecular pooling, tumor stage, tumor location, or cancer treatment. 2022 Aug 11. doi: 10.1007/s00455-022-10501-w. Online ahead of print. You have got a little something stuck in the valleculae (a shelf created by the epiglottis when it goes down to protect the airway). The consequences of dysphagia include dehydration, starvation, aspiration pneumonia and airway obstruction.1,2 Dysphagia may result from or complicate disorders such as stroke, Parkinson's disease and cancer. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. The epiglottic vallecula consists of a small mucosa-lined depression (vallecula) located at the base of the tongue just between the folds of the throat on either side of the median glossoepiglottic fold. Part of Springer Nature. What is the vallecula groove? V denotes the right vocal cord. This therapy is typically provided by a speech-language pathologist (and, more informally and adjunctively, by other healthcare professionals). Note how effective this maneuver was in clearing away the residual material seen in the prior photo. Indeed, many persons with an absent gag reflex have normal swallowing, and some patients with dysphagia have a normal gag reflex. (LAYR-inx) The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Principal treatments for selected disorders that affect swallowing are listed in Table 4. Powered by Black Line IT. In some patients, enteral feeding may be necessary to bypass the oral cavity and pharynx.1,19 In general, enteral feeding is indicated in any patient who is unable to achieve adequate alimentation and hydration by mouth. The purpose of this study was to determine the association between postswallow pharyngeal pooling and aspiration in HNC patients with OD, using a standardized FEES protocol. The authors declare that they have no conflict of interest. What causes pooling in the Vallecula? Complete IDDSI framework detailed definitions. Gargling with salt water can help dislodge them. 2007;116(11):83741. However, this approach is itself associated with increased risks of gastroesophageal reflux and aspiration pneumonia.25 Parenteral feeding is expensive, but it may be medically appropriate in patients who develop aspiration pneumonia on tube feedings. Pooling of bolus material is seen as any material that is present in the pharynx or larynx cavities before and/or after swallowing . A laryngocele is a protrusion of ciliated pseudostratified columnar epithelium and loose areolar connective tissue arising from saccular dilation of the appendix of the laryngeal ventricle. Impairments of the oral and pharyngeal phases are sometimes termed transfer dysphagias. However, severe vallecular pooling compared to no pooling was significantly associated with aspiration (OR 4.52, 95% CI 1.20, 16.97, p=0.026). The epiglottic vallecula consists of a small mucosa-lined depression (vallecula) located at the base of the tongue just between the folds of the throat on either side of the median glossoepiglottic fold. Head Neck. Epub 2013 Mar 5. Epub 2016 Jan 11. Appearance endoscopically at time of surgical resection. Laryngeal elevation is evaluated by placing two fingers on the larynx and assessing movement during a volitional swallow. Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: a systematic methodological review. Trapping the saliva in the vallecula prevents the swallowing reflex. In such cases, the material commonly pools in the vallecula and pyriform sinuses. Pharyngeal Residue Severity Rating Scales Based on Fiberoptic Endoscopic Evaluation of Swallowing: A Systematic Review. Crary MA, Mann GD, Groher ME. Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Dysphagia. The distribution of tumor stage among the included patients (i.e., 42 patients with T1 or T2 stage versus 33 patients with T3 or T4 stage) is considered fairly equal. However, discordant results on aspiration have been reported in HNC patients too. 12. **In the presence of isolated globus sensation with an otherwise normal history, physical exam and FOL/TNO, further investigation has low diagnostic yield*** Barium swallow study Fourteen patients (16.1%) underwent a tracheotomy. Arch Phys Med Rehabil. FOIA These depressions serve as spit traps; saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex. Tonsil stones in the crypts are usually harmless but can lead to bad breath and throat irritation. Valley rain causes pooling, concerns for ice. In such cases, the material commonly pools in the vallecula and pyriform sinuses. Hence, they require a mechanical soft diet. Lam P, et al. Send us your question and we'll respond within 24 hours. Disorders of the twelfth cranial nerve (hypoglossal nerve) cause weakness and wasting of the tongue on the affected side, affecting the swallowing and speech. Postswallow pharyngeal pooling may be a risk factor for tracheal aspiration. Histologically, the wall of the oropharynx is similar to that of the oral cavity. Laryngoscope. The categorical rating scale comprises three levels of pooling severity: no pooling (0), mild-to-moderate pooling (1), and severe pooling (2). Careers. Correction for pooling in the other location (pyriform sinuses versus valleculae) was performed to determine whether pooling location was associated with aspiration, independent of pooling in the other location. OD following oncologic treatment can lead to dietary restrictions, dehydration, malnutrition, aspiration pneumonia, and death [4,5,6]. Please enable it to take advantage of the complete set of features! Twenty-four (61.5%) of the patients showing postswallow vallecular pooling aspirated. Pooling occurs when a persons swallow does not successfully send the entire mass of food or liquid into the esophagus, so that some or all of the material remains in the hypopharynx. Patients with poor pharyngeal contraction usually have more pharyngeal retention with thickened liquids and chewed solid foods than with thin liquids. Abnormal swallowing, or inability to swallow. Endoscopic evaluation and treatment of swallowing disorders. Garca-Peris P, Parn L, Velasco C, de la Cuerda C, Camblor M, Bretn I, Herencia H, Verdaguer J, Navarro C, Clave P. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Pearson WG Jr, Davidoff AA, Smith ZM, Adams DE, Langmore SE. New York: Thieme; 2001. https://doi.org/10.5535/arm.2011.35.6.781. Aspiration occurred in 20 (52.6%) of the patients showing pyriform sinus pooling. The lower esophageal sphincter relaxes and allows propulsion of the bolus into the stomach. This injury could be the result of intubation four months earlier, or else of the continual coughing and throat clearing that occurs with this patients swallowing disorder. Congenital malformations are more typically identified in the younger population; inflammatory and infiltrative diseases, trauma, foreign bodies, and laryngeal cysts can be seen in all age groups; and Zenker and Killian-Jamieson diverticula tend to occur in the older population. However, the patient population included was a realistic representation of HNC patients consulting the multidisciplinary outpatient clinic for dysphagic complaints, which gives insight into the overall severity of swallowing impairment in this group. National Library of Medicine The specific indications and contraindications for these procedures remain unclear. It can also cling to the base of the tongue or the pharyngeal walls. The effect of severe pyriform sinus pooling compared to mild-to-moderate pooling on aspiration was not significant (OR 1.14, 95% CI 0.24, 5.44, p=0.867). Vallecular cysts are benign retention cysts of the minor salivary glands. The symptoms and signs of this disease may be nonspecific without apparent airway compromise. Both observers were blinded to the identity and medical history of the patient and to each others ratings (independent rating). Streptococcus A, B and C. Alterations in alveolar ventilation, atelectasis, mucus plugging, and recurrent respiratory Bethesda, MD 20894, Web Policies https://doi.org/10.2214/ajr.154.5.2108570. In the case described here, the patient's large, bilateral vallecular cysts caused dysphagia to both solids and liquids. Adult infectious epiglottitis may be unpredictable and difficult to diagnose definitively. Dysphagia. Aspiration was defined as bolus passing below the level of the vocal folds entering the trachea. All rights reserved. Causes [ 13] Neck surgeries - neck dissection, submandibular sialadenectomy, glomus, or schwannoma Skull base surgeries [ 6] Problems The viscosities (measured at 25 degrees Celsius 50s1 of shear rate) of the thin and thick liquid boluses were 1mPas and 1200mPas, respectively. The thyroid cartilage is the largest cartilage of the larynx and is composed of hyaline cartilage. Anatomical terminology The epiglottic vallecula is a depression (vallecula) just behind the root of the tongue between the folds in the throat. Rarely, a patient may be limited to foods with a pudding consistency if thin and thick liquids are freely aspirated. Moments later, the patient was asked to swallow again, but with chin tucked down towards chest. norwegian cruise line dining menus what causes pooling in the vallecula. This in turn may lead to postswallow aspiration, as observed during a videofluoroscopic swallow study (VFSS) in HNC patients [15]. Rather, it closes after the bolus enters the stomach, thereby preventing gastroesophageal reflux. However, many of the disorders that cause dysphagia, such as stroke or progressive bulbar palsy, are not amenable to pharmacologic therapy. This article reviews the basic concepts of normal and abnormal swallowing, methods of evaluating dysphagia, and treatment strategies, with emphasis on disorders of oral and pharyngeal swallowing. The air then goes down into your main airway (trachea) and into your lungs. All patients reported OD complaints. The mucosa includes a stratified squamous epithelium that is endowed with mucus-producing glands. Therefore, it was not possible to analyze the potential effect of these parameters on the association between pooling and aspiration. Sometimes swallowing difficulties, known as dysphagia, can accompany the pain, but odynophagia is often a condition of its own. The non-relaxing cricopharyngeus muscle (light-grey bulge outlined by a dotted line) is causing narrowing of the upper esophageal passageway, as highlighted by the narrowed stream of dark barium at that point (arrow). Epub 2022 Jan 11. No distinction was made between right- and left-sided pooling. Why Do Cross Country Runners Have Skinny Legs? 2004;130(9):11003. For pyriform sinus pooling, severe pooling was up to the level of the arytenoids. Postswallow pharyngeal pooling is defined as any portion of the bolus remaining in the valleculae and/or pyriform sinuses after the swallow, and it is considered to be a sign of impairment of deglutition [15, 16]. This area of the body is the empty space that is called the vallecula. SASS Clinical Note #1. The epiglottic valleculae are paired depressions in the oropharynx located anterior to the epiglottis and posterior to the base of tongue.. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. fordham university counseling psychology; what causes pooling in the vallecula Epiglottic cysts are benign lesions on the lingual or laryngeal aspect of the epiglottis and are often a result of mucus retention. Moreover, in previous studies the swallowing function was evaluated with a different assessment tool (VFSS), which may influence the results, considering that FEES may yield more severe scores for both pooling and penetration/aspiration, when compared to VFSS [28, 29]. Dysphagia. Similar results were seen following additional correction for tumor stage or tumor location. For safety concerns (risk of severe aspiration), 14 patients did not receive the entire FEES protocol (310cc thin, 310cc thick liquid): 3 patients only received thin liquid, and 11 patients only received thick liquid. A pureed diet is recommended for patients who exhibit difficulties with the oral preparatory phase of swallowing, who pocket food in the buccal recesses (between the teeth and cheek) or who have significant pharyngeal retention of chewed solid foods. Furthermore, nonstandardized bolus consistencies and/or varying volumes were administered across these studies [13, 16] and diverse rating scales for pharyngeal pooling were applied [16, 30]. PubMed Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. , For an object deeper in the nose, pinch the clear side of the nose closed. 1 Hypertrophy of the lingual tonsils has several clinical implications such as dysphagia, upper airway obstruction, difficult intubation, and difficult gastrointestinal endoscopy because the lingual tonsils are located in the tongue base. air force epr rating scale brian steele bristol bateman skips def jam fight for ny blazin' moves list velocette factory records. However, the most common bacteria causing infectious epiglottitis in adults currently are Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus. Saliva on the back wall of the nasopharynx (where it doesnt belong) is also a clue. See permissionsforcopyrightquestions and/or permission requests. Other studies using VFSS mainly in patients with neurogenic OD did not show any association between pyriform sinus pooling and aspiration [16, 27]. The protocol of this training has been described in previous studies [19, 21]. What are the side effects of Thiazolidnedions. In this procedure, the cricopharyngeus muscle is disrupted to reduce resistance of the pharyngeal outflow tract.8 This procedure is occasionally coupled with suspension of the thyroid cartilage, which is performed to improve laryngeal elevation. HNC patients with complaints of OD who underwent a FEES examination at the Maastricht University Medical Center outpatient clinic between 2009 and 2016 were enrolled in the study. This elderly man is having a hard time swallowing solids. To evaluate the pharyngeal phase of swallowing, fiberoptic endoscopic evaluation of swallowing (FEES) is deemed a reliable, safe, and well-tolerated tool. The videofluorographic swallowing study (VFSS)* is the gold standard for evaluating the mechanism of swallowing.17,18 For this study, the patient is seated comfortably and given foods mixed with barium to make them radiopaque. What happens if the valleculae overflow before swallowing occurs? Pooling occurs when a persons swallow does not successfully send the entire mass of food or liquid into the esophagus, so that some or all of the material remains in the hypopharynx. 5th June 2022 . a : a groove between the base of the tongue and the epiglottis. https://doi.org/10.1177/000348940010900315. Location of vagus nerve injury is sometimes evident by palate and pharynx findings. The measurement of observer agreement for categorical data. Aspirating material into the distal airways is more dangerous than aspirating material into the trachea. Patients with impaired level of consciousness, massive aspiration, silent aspiration, esophageal obstruction or recurrent respiratory infections often require enteral feeding. This is technically penetration, and not aspiration. However, the effect of severe pyriform sinus pooling compared to no pooling on aspiration was significant (OR 4.86, 95% CI 1.70, 13.91, p=0.003). Which comes first Laryngopharynx or larynx? The following exclusion criteria were applied: HNC and a concurrent neurologic disease; a Mini Mental State Examination score below 23; older than 85years; having undergone a total laryngectomy; having a recurrent HNC or a second primary tumor, and osteoradionecrosis of the maxilla or mandible. The third objective is to acquire clues to the etiology of the condition. and transmitted securely. It is usually not seen by the naked eye as it is far back and deep at the root of the . https://doi.org/10.1007/s00455-016-9775-x. The function of the depression is to serve as a trap for saliva and occasionally food. FEES images were obtained using a Xion SD camera, XionEndoSTROB E camera control unit (PAL 25 fps), and Matrix DS datastation with DIVAS software (Xion Medical, Berlin, Germany). How do I keep my cables tidy behind my TV? As the bolus may spill from the lateral parts of the valleculae, the overflow of the bolus from the valleculae directly into the laryngeal vestibule seems less likely to happen. With dysfunction of the pharyngeal phase of swallowing, food transport to the esophagus may be impaired. The vallecula is the air pocket found at the level of the hyoid bone just anterior to the epiglottis. The analysis was also adjusted for the influence of tumor stage (T34 vs. T12), tumor location (pharynx tumor versus non-pharynx tumor), and cancer treatment (only radiotherapy, only surgery, or multimodality treatment). Late dysphagia after radiotherapy-based treatment of head and neck cancer. This closer view within the larynx shows not only soiling of the laryngeal vestibule with saliva bubbles, but also a left contact granuloma (right of image). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2007;26(6):7107. Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Evaluating Swallowing Function among Patients with Amyotrophic Lateral Sclerosis and Dysphagia. Reduced tongue function/coordination. Also the phenomena of pooling in both locations (pyriform sinuses and valleculae) probably indicate a more severe swallowing impairment with an increased risk of aspiration [27]. You may have chronic aspiration if this occurs frequently. Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase. For instance, walking is generally the best exercise to improve ambulation skills. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. Wu CH, Hsiao TY, Ko JY, Hsu MM. If food and debris gets trapped in the pockets and folds of your tonsils, it can harden into yellow or white deposits called tonsil stones. Surgery is rarely indicated in patients with oral or pharyngeal dysphagia, but it can be effective in selected patients. To our knowledge, no studies have explored the potential association between postswallow pharyngeal pooling and aspiration in a more general HNC population using FEES. These mechanisms include ciliary action and coughing. Dysphagia. Three-point ordinal scales (range 02) were used to capture pooling severity. These FEES outcome variables were described in previous studies and are presented in the supplementary material (Table S1) [20, 21]. This is a week after laser excision of this mass. Clin Otolaryngol. Jung SJ, Kim DY, Joo SY. Ninety patients (81.1% men) were included in the study. Some people may wheeze, have trouble breathing, or have a hoarse voice after they eat, drink, vomit, or experience heartburn. It plays an important role in transferring air from the nose to the larynx. Blue-stained applesauce the patient has attempted to swallow replaces the saliva in the right pyriform sinus, but there is no soiling of the laryngeal vestibule (initial opening to the airway). 2017 Feb;32(1):27-38. doi: 10.1007/s00455-016-9775-x. Supplemental studies are usually required. Citation, DOI & article data. Accessibility Arch Otolaryngol Head Neck Surg. Pulmonary clearance mechanisms. Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. This study investigates the relationship between postswallow pharyngeal pooling and aspiration in HNC patients with oropharyngeal dysphagia. Impaired swallowing, or dysphagia, may occur because of a wide variety of structural or functional conditions, including stroke, cancer, neurologic disease and gastroesophageal reflux disease. Would you like email updates of new search results? Pooling is often caused by presbyphagia, and its occurrence may put a patient at risk of aspiration. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma.
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