D. Kühn

Electrical Stimulation in Treatment of Pharyngolaryngeal Dysfunctions

Objective: Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge. Methods: We conducted a selective literature search using PubMed. Results: In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found. Conclusion: Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.

Schlucken und Schluckstörungen im Alter

ZusammenfassungIn jedem Lebensalter kann es vorkommen, dass der Schluckvorgang nicht regelrecht abläuft und es zum Verschlucken kommt. Das Risiko einer Schluckstörung steigt allerdings mit höherem Alter. Dies liegt neben der erhöhten Inzidenz von Erkrankungen, die mit einem Dysphagierisiko einhergehen, auch an altersbedingten Veränderungen der Schluckorgane und -funktionen. Vom Alterungsprozess sind alle am Schluckvorgang beteiligten anatomischen Strukturen betroffen. Störungen können somit in der oralen, pharyngealen und/oder ösophagealen Schluckphase auftreten. Zu den wesentlichen Veränderungen gehören Einschränkungen der Kaufunktion, eine verzögerte Schluckreflextriggerung, eine Erweiterung der Pharynxstrukturen, eine verlängerte pharyngeale Propulsion, ein Sensibilitätsverlust im Pharynx, eine rigidere Ösophaguswand und eine reduzierte ösophageale Kontraktionskraft. Rein altersbedingte Veränderungen des Schluckens werden als Presbyphagie bezeichnet. Sind diese Veränderungen so gravierend, dass sie nicht mehr kompensiert werden können, spricht man von einer Presbydysphagie. Für die Diagnostik und Therapieplanung ist es wichtig, presbyphagische und presbydysphagische Veränderung sicher einzuordnen und von altersunabhängigen Dysphagieursachen abzugrenzen.AbstractDisturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.Disturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.

[Medication-induced dysphagia : A review].

ZusammenfassungDas Schlucken als hochdifferenzierter physiologischer Vorgang kann durch viele Faktoren beeinträchtigt werden. Vorrangig beschrieben sind Schluckstörungen durch anatomisch-mechanische Ursachen, Operationen im Kopf-Hals-Bereich bei Tumoren, Schilddrüsenveränderungen und neuromuskulären Veränderungen. Die mit dem Alter gehäuft auftretenden zerebral-neurologischen und gefäßbedingten Veränderungen können ebenfalls eine Dysphagie (sog. Presbydysphagie) auslösen oder verstärken.Deutlich seltener werden medikamentenassoziierte Schluckstörungen erkannt, nicht hinreichend beachtet oder stillschweigend akzeptiert, insbesondere wenn sie bei älteren Patienten auftreten. Außerdem wird die pharmakologische Interferenz verschiedener Medikamente insbesondere bei multipler Medikation häufig nicht hinreichend berücksichtigt.Die Therapie beinhaltet zuerst die kritische Hinterfragung der aktuellen Medikation mit dem Ziel der Reduktion/des Absetzens der auslösenden Medikamente, präzise Anweisungen bezüglich der Medikamenteneinnahme, eine antazide Medikation und Diät neben einem professionellen oralen Stimulations- oder Phagietraining.Bis heute sind medikamenteninduzierte Schluckbeschwerden nicht im Fokus von Ärzten und Therapeuten, obwohl viele Wirkstoffe eine negative Auswirkung auf das Schlucken haben können und speziell im höheren Alter eine medikamentenassoziierte Dysphagie durch eine multiple Medikation nicht selten ist. Dieser Artikel gibt eine Übersicht der verschiedenen Medikamentenklassen bezüglich ihrer negativen indirekten oder direkten Wirkung auf die Schluckfunktion.AbstractAs a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.

[A phonation-related phase-model of the velopharyngeal closure based on high resolution manometry].

OBJECTIVE The production of many speech sounds requires a complete velopharyngeal closure (VPC) caused by muscular contractions and approximation of the pharyngeal walls. The contraction pressure of the muscles involved needs to be high enough to withstand phonation pressure. It is postulated that sustained phonation consists of 3 velopharyngeal phases: an initial pressure buildup, a steady state and a final pressure decrease. To test this hypothesis, phonation induced pressure changes in the VPC were measured in healthy participants. MATERIAL AND METHODS High resolution manometry was performed on 8 participants during the sustained phonation of the vowel / i:/. Individual pressure curves have been compared in order to verify the postulated model and intraindividual reproducibility has been tested. RESULTS The intraindividual pressure curves were found to be reproducible, but an interindividual variation was observed. An initial pressure increase was detected in all participants at the onset of phonation, followed by a stable phase during sustained phonation. At the offset the pressures returned to the initial value during rest. CONCLUSIONS The postulated model was verified in all participants. An initial phase, a stable phase and a terminal phase could be differentiated. Further classifications can be made regarding the on- and offset of phonation allowing for a more detailed characterization of the VPC. Further studies should evaluate if this model is useful to describe changes in the VPC pressure profile of patients affected by rhinophonia.

High resolution manometry study of pharyngeal function in patients with myotonic dystrophy

BACKGROUND Patients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry. METHOD In two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects. RESULTS In both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed. CONCLUSION The force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.ZusammenfassungHintergrundBei Patienten mit myotoner Dystrophie (MD) sind oropharyngeale Dysphagien und Motilitätsstörungen des Ösophagus nicht ungewöhnlich und häufig die Ursache für Aspirationspneumonien. Über die pharyngeale Kontraktionskraft und die Öffnungsfunktion des oberen Ösophagussphinkters (oÖS) ist bei diesen Patienten bisher wenig bekannt, insbesondere liegen nur wenige Daten aus manometrischen Untersuchungen vor, die eine Einschätzung des pharyngealen Druckaufbaus während des Schluckens ermöglichen. Ziel dieser Studie war es, solche Daten bei Patienten mit MD hochauflösungsmanometrisch zu erheben.MethodikBei zwei Patienten mit MD wurden hochauflösungsmanometrische Untersuchungen während des Schluckens und der Phonation durchgeführt und druckabhängige Parameter ermittelt. Die Ergebnisse wurden mit Normwerten gesunder Probanden verglichen.ErgebnisseBei beiden Patienten wurde ein verminderter Druck im gesamten Pharynxareal während des Schluckens ermittelt. Auch die Kontraktionsdauer im Velopharynx und im Zungengrundbereich war verkürzt. Der strukturelle Ablauf des Schluckvorgangs und die Öffnungsfunktion des oÖS waren regulär. Bei Realisation geschlossener Vokale war ein verminderter Druckaufbau im velopharyngealen Abschluss festzustellen.DiskussionDie Kontraktionskraft und der damit verbundene pharyngeale Druckaufbau während des Schluckens waren vermindert, sodass eine inkomplette Klärung des Pharynx resultierte, die Ursache für eine postdeglutitive Aspiration sein kann. Neben myopathischen sind auch neuromuskuläre Störungen anzunehmen, der funktionelle Ablauf des Schluckvorgangs und das Schluckmuster waren aber erhalten. Der verminderte Druckaufbau im Velopharynx ist als Ursache für rhinophone Beschwerden der Patienten anzusehen. Eine hochauflösungsmanometrische Untersuchung ist neben der Basisdiagnostik bei Patienten mit MD sinnvoll, um die pharyngeale Funktion und die Funktion des oÖS zu beurteilen.SummaryBackgroundPatients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry.MethodIn two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects.ResultsIn both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed.ConclusionThe force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.

Physiology of the upper esophageal sphincter

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology.ZusammenfassungIm pharyngoösophagealen Abschnitt dient der obere Ösophagussphinkter (oÖS) als Verschluss zwischen Pharynx und Ösophagus. Bei Öffnung ermöglicht er die Speiseboluspassage in den Ösophagus sowie auch die Emesis und Eruktation. In Ruhe übt der oÖS einen permanenten Tonus aus und dient damit als Barriere zur Refluxvermeidung und zur Verhinderung einer passiven Aerophagie bei tiefer Atmung. Der Ruhetonus des oÖS ist von mehreren Einflussfaktoren abhängig, während des Schluckvorgangs zeigt der Sphinkter einen mehrphasigen komplexen Öffnungs- und Schließungsvorgang. Dieser Artikel gibt einen Überblick über den aktuellen Wissensstand zur Physiologie des oÖS.AbstractThe upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology.

Anatomy of the upper esophageal sphincter

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When closed, the barrier function serves to prevent reflux and aerophagia; when open, swallowing, belching and vomiting are possible. The closing muscles include caudal parts of the inferior pharyngeal sphincter and cranial parts of the upper esophagus musculature. Sphincter opening is achieved by muscles that insert from the outside to connect to the larynx and pharynx in the sphincter region. The closing muscles are innervated by branches of the glossopharyngeal and vagal nerves, and central control is probably mediated by several reflexes. This article presents an overview of the current understanding of the complex UES anatomy.

Hochauflösungsmanometrische Untersuchung der pharyngealen Funktion bei myotoner Dystrophie

BACKGROUND Patients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry. METHOD In two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects. RESULTS In both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed. CONCLUSION The force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.ZusammenfassungHintergrundBei Patienten mit myotoner Dystrophie (MD) sind oropharyngeale Dysphagien und Motilitätsstörungen des Ösophagus nicht ungewöhnlich und häufig die Ursache für Aspirationspneumonien. Über die pharyngeale Kontraktionskraft und die Öffnungsfunktion des oberen Ösophagussphinkters (oÖS) ist bei diesen Patienten bisher wenig bekannt, insbesondere liegen nur wenige Daten aus manometrischen Untersuchungen vor, die eine Einschätzung des pharyngealen Druckaufbaus während des Schluckens ermöglichen. Ziel dieser Studie war es, solche Daten bei Patienten mit MD hochauflösungsmanometrisch zu erheben.MethodikBei zwei Patienten mit MD wurden hochauflösungsmanometrische Untersuchungen während des Schluckens und der Phonation durchgeführt und druckabhängige Parameter ermittelt. Die Ergebnisse wurden mit Normwerten gesunder Probanden verglichen.ErgebnisseBei beiden Patienten wurde ein verminderter Druck im gesamten Pharynxareal während des Schluckens ermittelt. Auch die Kontraktionsdauer im Velopharynx und im Zungengrundbereich war verkürzt. Der strukturelle Ablauf des Schluckvorgangs und die Öffnungsfunktion des oÖS waren regulär. Bei Realisation geschlossener Vokale war ein verminderter Druckaufbau im velopharyngealen Abschluss festzustellen.DiskussionDie Kontraktionskraft und der damit verbundene pharyngeale Druckaufbau während des Schluckens waren vermindert, sodass eine inkomplette Klärung des Pharynx resultierte, die Ursache für eine postdeglutitive Aspiration sein kann. Neben myopathischen sind auch neuromuskuläre Störungen anzunehmen, der funktionelle Ablauf des Schluckvorgangs und das Schluckmuster waren aber erhalten. Der verminderte Druckaufbau im Velopharynx ist als Ursache für rhinophone Beschwerden der Patienten anzusehen. Eine hochauflösungsmanometrische Untersuchung ist neben der Basisdiagnostik bei Patienten mit MD sinnvoll, um die pharyngeale Funktion und die Funktion des oÖS zu beurteilen.SummaryBackgroundPatients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry.MethodIn two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects.ResultsIn both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed.ConclusionThe force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.

Swallowing and dysphagia in the elderly

ZusammenfassungIn jedem Lebensalter kann es vorkommen, dass der Schluckvorgang nicht regelrecht abläuft und es zum Verschlucken kommt. Das Risiko einer Schluckstörung steigt allerdings mit höherem Alter. Dies liegt neben der erhöhten Inzidenz von Erkrankungen, die mit einem Dysphagierisiko einhergehen, auch an altersbedingten Veränderungen der Schluckorgane und -funktionen. Vom Alterungsprozess sind alle am Schluckvorgang beteiligten anatomischen Strukturen betroffen. Störungen können somit in der oralen, pharyngealen und/oder ösophagealen Schluckphase auftreten. Zu den wesentlichen Veränderungen gehören Einschränkungen der Kaufunktion, eine verzögerte Schluckreflextriggerung, eine Erweiterung der Pharynxstrukturen, eine verlängerte pharyngeale Propulsion, ein Sensibilitätsverlust im Pharynx, eine rigidere Ösophaguswand und eine reduzierte ösophageale Kontraktionskraft. Rein altersbedingte Veränderungen des Schluckens werden als Presbyphagie bezeichnet. Sind diese Veränderungen so gravierend, dass sie nicht mehr kompensiert werden können, spricht man von einer Presbydysphagie. Für die Diagnostik und Therapieplanung ist es wichtig, presbyphagische und presbydysphagische Veränderung sicher einzuordnen und von altersunabhängigen Dysphagieursachen abzugrenzen.AbstractDisturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.Disturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.

Videoendoskopische Darstellung der Konfigurationsänderungen im Larynx und Pharynx bei definierten Schluckmanövern

BACKGROUND Traditional dysphagia therapy (TDT) aims to improve swallowing by means of compensatory strategies including postural changes or swallowing maneuvers. These techniques are mainly applied in order to modify swallowing by affecting bolus transport to facilitate safe swallowing. Videos demonstrating actual, laryngoscopically verified effects on the pharyngeal and laryngeal structures involved are rare in the current literature. This paper aims to assess various maneuvers used in TDT endoscopically. METHOD A selective literature search for endoscopic imaging of swallowing maneuvers and postural changes applied in TDT was performed in PubMed. RESULTS Each of the techniques commonly used in TDT influenced the pharyngeal or laryngeal structures distinctly. DISCUSSION All of the techniques examined for this paper represent techniques commonly applied in traditional dysphagia therapy. The specific changes observed endoscopically of the anatomic structures involved are distinct, but sometimes seem only marginal in comparison to the initial configurations. It should hence not be surprising that these swallowing techniques occasionally only slightly improve swallowing. The videos included in this article demonstrate the actual impact of the swallowing techniques and may therefore be of use to physicians prescribing and implementing TDT.