Patients and Treatment of Dysphagia in our Hospital

Abstract

The department of otorhinolaryngology in our hospital opened the Outpatient Clinic of Dysphagia in 1999, and has diagnosed and treated dysphagia caused by various diseases. At present, our hospital has an established system involving preparation and dissemination of a diagnostic flow chart to each department in order to evaluate dysphagia for patients with cerebrovascular disorders and who are at risk of dysphagia. Once identified, these patients are transferred to the Outpatient Clinic of Dysphagia at once so as to catch dysphagia at an early stage.
First, an otorhinolaryngologist examines the movement and sensory perception of the oral cavity, pharynx and larynx in all patients using a laryngeal fiberscope. For some patients, the presence or absence of flow into the larynx is then examined by swallowing a solution under fiberscopic observation and while having videofluorography (VF) performed. The treatment includes training by a swallowing therapist (ST), and/or surgery to improve swallowing or to prevent accidental swallowing, on a case-by-case basis. The authors studied 120 patients who had consulted the Outpatient Clinic of Dysphagia of our hospital from April 2001 to March 2003. Fifty-four patients required training, surgery or other treatment, and 25 of them were treated with only by training. In combination with training, tracheotomies were performed on 10 patients, ; laryngeal elevation surgery/ cricopharyngeal myotomies with 3, ; tracheoesophageal diversions on 10, and laryngectomies in 6. Twenty-two patients could take food by mouth at the first visit. Oral feeding became possible in 96 out of 120 patients after the treatment, including those who were trained as well as treated by surgery.