Speech Pathologist Practice Patterns for Evaluation and Management of Suspected Cricopharyngeal Dysfunction

Abstract

Speech pathologists are often the first professionals to identify signs of a cricopharyngeal (CP) dysfunction and make recommendations for further care. There are many care options for patients with CP dysfunction, but it is unclear how certain interventions are used in practice. A paper-based survey employing two clinical cases involving suspected CP dysfunction (Case 1 with adequate pharyngeal strength and Case 2 with coexisting pharyngeal weakness) were sent to members of American Speech-Language Hearing Associations Special Interest Group 13. Respondents ranked the order of management approaches (swallowing therapy, further evaluation, and referral to another medical professional) and selected specific interventions under each approach that they would recommend for each case. Completed surveys from 206 respondents were entered into analysis. The majority of the respondents recommended swallowing therapy as a first approach for each case (Case 1: 64%; Case 2: 88%). The most prevalent swallowing exercises recommended were the Shaker (73%), effortful swallow (62%), and Mendelsohn maneuver (53%) for Case 1 and the effortful swallow (92%), Shaker (84%), and tongue-hold swallow (73%) for Case 2. Seventy-six percent of respondents recommended a referral for Case 1, while 38% recommended the same for Case 2. Respondents with access to more types of evaluative tools were more likely to recommend further evaluation, and those with access only to videofluoroscopy were less likely to recommend further evaluation. However, the high degree of variability in recommendations reflects the need for best practice guidelines for patients with signs of CP dysfunction.

Dysphagia Practice in 2035: Beyond Fluorography, Thickener, and Electrical Stimulation

“…That is, many providers report trying a wide variety of strategies in most patients (compensations, range of motion, strengthening, among others) and prescribe exercises on a daily, high-intensity schedule. [155][156][157] Given the extreme complexity of swallowing, current exercise regimens, even when performed intensively, appear inadequate to rehabilitate the complex swallowing abnormalities typically seen in patients with moderate or severe dysphagia and are reported to have small to moderate effects. 143 Furthermore, ever growing reimbursement reductions, caps, and the emerging focus on value-based health care threaten (rightfully so) extant practices wherein relatively similar therapies are applied for long treatment periods regardless of etiology or progress.…”

Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia

“…The dysfunction of the upper esophageal sphincter (UES) can significantly hinder the recovery of patients with dysphagia. [1] Botulinum toxin injection is a widely used procedure for the treatment of UES dysfunction. [2]…”

Effect of Shaker Exercises on Swallowing Disturbance among Patients with Hyperthyroidism at a Selected University Hospital

“…Shaker exercise is currently the most commonly recommended swallowing exercise by speech-language pathologists for the treatment of dysphagia and based on different studies done for different patients have different disorders as head and neck cancer, stroke and parkinson disease reported that shaker exercise is effective to reduce intensity of dysphagia and improve swallowing abilities but there is no enough researches or scanty number of researches have been conducted to investigate the effect of shaker exercise on dysphagia among patients with hyperthyroidism (Kraaijenga, et al, 2017) [12], (Park ,Hwang ,Oh &Chang, 2017) [14], (Langmore & Pisegna, 2015) [16], (DeJong, 2016) [1] and (Jones, Knigge & McCulloch, 2014) [17].…”