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Oropharyngeal dysphagia — Clinical Guidelines

Overview

Oropharyngeal dysphagia involves impaired movement of food or liquid from the mouth to the esophagus, often leading to complications such as malnutrition, dehydration, and aspiration pneumonia, particularly in geriatric populations 6.

Diagnosis

Clinical Assessment: Includes patient history and physical examination focusing on swallowing difficulties.

Instrumental Evaluations: Videofluoroscopic swallow study (VFSS) is considered the gold standard 5 6.

Subjective Interpretation: Widely used by clinicians despite variability in accuracy 5.

Multidisciplinary Approach: Recommended for comprehensive evaluation, combining otolaryngology and speech therapy assessments 9.

Management

Speech Therapy: Primary intervention aimed at reducing aspiration risk and improving swallowing function 3 7.

Diet Modifications: Adjustments based on severity, often guided by instrumental studies and clinical judgment 1.

Nutritional Support: Early initiation of oral intake post-intubation with speech therapy shows efficacy in reducing tube feeding duration 3.

Antioxidant Supplementation: Consideration for patients with severe dysphagia to address potential deficiencies 4.

Special Populations

Elderly: Higher prevalence and severity of dysphagia, often underdiagnosed and untreated 6.

Post-Intubation Patients: Early speech therapy intervention can significantly shorten the duration of tube feeding 3.

Key Recommendations

Implement speech therapy early in the management of post-intubation oropharyngeal dysphagia to expedite oral intake restoration (Evidence: Strong 3).

Utilize videofluoroscopic swallow studies (VFSS) as the primary instrumental assessment tool for diagnosing oropharyngeal dysphagia (Evidence: Moderate 5 6).

Consider multidisciplinary approaches involving otolaryngology and speech therapy for comprehensive dysphagia evaluation and management (Evidence: Expert opinion 9).

Monitor and address nutritional status, particularly antioxidant levels, in patients with severe dysphagia (Evidence: Moderate 4).

Provide tailored dietary modifications based on instrumental and clinical assessments to minimize aspiration risk (Evidence: Expert opinion 1 7).

References

1 Belmonte MS, Pedreira LC, Gomes NP, Oliveira DV, Souza ACFSE, Pinto IS. Home caregiver strategies for feeding older adults with dysphagia after dehospitalization. Revista da Escola de Enfermagem da U S P 2024. link 2 North M, Holmes S. A case study of the development of a videofluoroscopy service: Integration and collaboration between the speech & language therapy and radiographer teams. Radiography (London, England : 1995) 2023. link 3 Turra GS, Schwartz IVD, Almeida ST, Martinez CC, Bridi M, Barreto SSM. Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial. CoDAS 2021. link 4 Homem SG, Moreira EAM, da Silva AF, Barni GC, da Rosa JS, Oliveira DL et al.. Relationship between oropharyngeal dysphagia, nutritional status, antioxidant vitamins and the inflammatory response in adults and elderly: A cross-sectional study. Clinical nutrition ESPEN 2020. link 5 Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective Assessment of Videofluoroscopic Swallow Studies. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 6 Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF et al.. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clinical interventions in aging 2016. link 7 Hegland KW, Murry T. Nonsurgical treatment: swallowing rehabilitation. Otolaryngologic clinics of North America 2013. link 8 Cocks N, Ferreira H. What information do UK speech and language therapists use when making oral versus nonoral feeding recommendations for adults with oropharyngeal dysphagia?. Dysphagia 2013. link 9 Santoro PP, Furia CL, Forte AP, Lemos EM, Garcia RI, Tavares RA et al.. Otolaryngology and speech therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal. Brazilian journal of otorhinolaryngology 2011. link

Oropharyngeal dysphagia