Bedside evaluation of deglutition

Abstract

Dysphagia refers to a series of movement failures that prevent uptake of food and passage of food to the stomach. When it is caused by neurological disease, the patient rarely complains of dysphagia. Dysphagia is first assessed in these patients by bedside observation and is suspected if any of the following are present : an increase in sputum, choking, a wet husky voice, food mixing with sputum, a sense of discomfort in the pharynx, decreased appetite, fatigue during eating, prolongation of mealtime, a change in eating performance, and weight loss. Further evaluation of deglutition can then be performed at the time of the first medical examination or at the time of hospitalization. These examinations include the repetitive saliva swallowing test and modified water swallowing test ; videofluoroscopy, in which the deglutition–related organic state and movement are assessed ; and videoendoscopy, which enables serial evaluation at the bedside. A treatment strategy is then decided to prevent aspiration of food and food from remaining in the pharynx after swallowing. Dysphagia also affects the intake of medicine, and can interfere with medical treatment. Medicine in any form, including tablets, capsules, orally disintegrating tablets, and powdered medicine, can leave behind residue in the oral or pharyngeal cavity when taken by patients with dysphagia. Accordingly, careful observation is required.