2016 年 33 巻 2 号 p. 206-209
If we try to treat dysphagia patients by single department or single profession, we might fail. Fortunately, many professions such as nurses, speech language pathologists, pharmacists, nutritionists, and dentists also participate in therapy for dysphagia these days.
In this manuscript, I mentioned three roles of otolaryngologists : a) to coordinate team approach by a bird's–eye view, b) pathological and physiological diagnosis of dysphagia, and c) surgical interventions.
a) To help patients who are suffered from disability, surgical or medical treatment are not enough. As a doctor in charge, it is important to coordinate team approach by a bird's–eye view. We are able to understand our patients precisely according to the ICF ; International Classification of Functioning, Disability and Health.
b) Accurate physiological diagnosis or understanding mechanisms of dysphagia is essential to make an appropriate rehabilitation plan. We always analyze mechanisms of dysphagia anatomically by two types of tests, videofluorograpy ; VF and fiberendoscopic evaluation of swallowing ; FEES.
c) It is important duty for medical doctors not to miss a treatable dysphagia. Sometimes surgical interventions can play a role effectively. They can be classified into two classes : surgery for improving function of swallowing and preventive surgery against aspiration. Surgery for improveing function of swallowing such as laryngeal suspention, cricopharyngeal myotomy or arytenoid adduction, in which procedure phonation is preserved. Selection of method is depend on mechanism of dysphagia. Preventive surgery against aspiration such as total laryngectomy, laryngotracheal separation, and glottal closure, is effective for chronic aspiration. Selection of method is depend upon patients general status.
