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Book Details
Abstract
Get a quick, expert overview of the many aspects of the evaluation and management of dysphagia from a team of experts in the field, led by otolaryngologists Drs. Dinesh K. Chhetri at UCLA’s David Geffen School of Medicine and Karuna Dewan at Stanford University. This practical resource presents a focused summary of today’s current knowledge on anatomy and physiology of swallowing, assessment of swallowing, and treatment of dysphagia. It’s an easy-to-read, one-stop resource for staying up to date in this high-demand area.
- Features up-to-date information on assessment of swallowing, including the physical exam, FEES, TNE, MBSS, Barium Esophagram, and HRM.
- Offers current coverage of dysphagia treatment, including Neurologic Dysphagia; Chemoradiation-induced Dysphagia; Epiglottic Dysfunction; Cervical Osteophytes; Glottic Insufficiency; Cricopharyngeal Achalasia; Zenker’s Diverticulum; Dysphagia After Laryngectomy; Esophageal Dysphagia; Eosinophilic Esophagitis; and Swallowing Therapy.
- Discusses future directions in dysphagia treatment.
- Consolidates today’s available information on this timely topic into one convenient resource.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Dysphagia Evaluation and Management in Otolaryngology | i | ||
| Dysphagia Evaluation and Management in Otolaryngology | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Preface | vii | ||
| Contents | ix | ||
| 1 - ANATOMY AND PHYSIOLOGY OF SWALLOWING | 1 | ||
| 1 -\rGeneral Principles of Swallowing | 1 | ||
| INTRODUCTION | 1 | ||
| BASIC CONCEPTS OF SWALLOWING | 1 | ||
| ETIOLOGIES OF DYSPHAGIA | 2 | ||
| CONCLUSIONS | 3 | ||
| 2 \r- The Oral Cavity | 5 | ||
| INTRODUCTION | 5 | ||
| EMBRYOLOGY | 5 | ||
| ANATOMY | 5 | ||
| Lips and Cheeks | 5 | ||
| Palate | 6 | ||
| Floor of the Mouth | 6 | ||
| Tongue | 8 | ||
| Masticatory Muscles | 9 | ||
| Teeth | 10 | ||
| PHYSIOLOGY | 10 | ||
| Oral Preparatory Phase | 10 | ||
| Oral Transport Phase | 10 | ||
| Role of Saliva in Swallowing | 11 | ||
| REFERENCES | 12 | ||
| 3 -\rOropharynx | 13 | ||
| INTRODUCTION | 13 | ||
| EMBRYOLOGY AND DEVELOPMENT | 13 | ||
| Tongue Development | 13 | ||
| Palate Development | 14 | ||
| Postnatal Development | 14 | ||
| ANATOMY | 15 | ||
| Soft Palate | 15 | ||
| Tongue | 15 | ||
| Palatine Tonsils and Tonsillar Fossa | 16 | ||
| Pharyngeal Wall | 16 | ||
| PHYSIOLOGY AND FUNCTION IN SWALLOW | 16 | ||
| Neurologic Control of Oropharyngeal Swallow | 19 | ||
| Variability in Swallow Initiation | 19 | ||
| Pharyngeal Manometry | 19 | ||
| SUMMARY | 20 | ||
| REFERENCES | 20 | ||
| 4 -\rLarynx | 23 | ||
| INTRODUCTION | 23 | ||
| EMBRYOLOGY | 23 | ||
| ANATOMY | 24 | ||
| Cartilage and Ligaments | 24 | ||
| Muscles | 25 | ||
| Innervation | 25 | ||
| Vascular Supply | 25 | ||
| Lymphatic | 26 | ||
| PHYSIOLOGY AND FUNCTION IN SWALLOWING | 26 | ||
| CONCLUSIONS | 27 | ||
| REFERENCES | 27 | ||
| 5 -\rAnatomy and Physiology of the Upper Esophageal Sphincter | 29 | ||
| INTRODUCTION | 29 | ||
| EMBRYOLOGY | 29 | ||
| ANATOMY | 29 | ||
| Upper Esophageal Sphincter Closing Muscles | 29 | ||
| Cricopharyngeus | 29 | ||
| Innervation | 29 | ||
| Inferior pharyngeal constrictor | 30 | ||
| II - ASSESSMENT OF SWALLOWING | 41 | ||
| 7 -\rDysphagia Evaluation | 41 | ||
| INTRODUCTION | 41 | ||
| HISTORY TAKING | 41 | ||
| PHYSICAL EXAMINATION | 42 | ||
| INSTRUMENTAL EXAMS | 43 | ||
| CONCLUSIONS | 43 | ||
| REFERENCES | 43 | ||
| 8 -\rFlexible Endoscopic Evaluation of Swallowing | 45 | ||
| INTRODUCTION | 45 | ||
| TECHNOLOGY | 46 | ||
| TECHNIQUE | 47 | ||
| Patient Positioning | 47 | ||
| Nasal Anesthesia | 47 | ||
| Observation of Swallowing Anatomy | 47 | ||
| Observation of Swallowing Function | 47 | ||
| Assessment of Compensatory Swallowing Techniques | 48 | ||
| COMMON FINDINGS | 49 | ||
| Premature Spillage | 49 | ||
| Vallecular Residue | 49 | ||
| Piriform Sinus Residue | 49 | ||
| Nasal Regurgitation | 49 | ||
| Combined Vallecular and Piriform Sinus Residue | 49 | ||
| Penetration | 50 | ||
| Aspiration | 51 | ||
| Esophagopharyngeal reflux | 51 | ||
| SUMMARY | 52 | ||
| REFERENCES | 52 | ||
| 9 -\rTransnasal Esophagoscopy | 55 | ||
| INTRODUCTION | 55 | ||
| TECHNOLOGY | 56 | ||
| TECHNIQUE | 57 | ||
| Technique of Flexible Transnasal Esophagoscopy | 57 | ||
| CASE EXAMPLES | 58 | ||
| Case 1 | 58 | ||
| Advantage of TNE | 58 | ||
| Case 2 | 58 | ||
| Management | 59 | ||
| Advantage of TNE | 59 | ||
| Case 3 | 59 | ||
| III - TREATMENT OF DYSPHAGIA | 99 | ||
| 13 -\rDeveloping the Optimal Treatment Strategy for Dysphagia | 99 | ||
| INTRODUCTION | 99 | ||
| DEVELOPING THE OPTIMAL TREATMENT PLAN TOGETHER | 99 | ||
| DECISION MAKING FOR SURGICAL INTERVENTION | 100 | ||
| DECISION MAKING FOR SWALLOW THERAPY | 102 | ||
| THE TERRIBLE TRIAD TO OVERCOME | 103 | ||
| CONCLUSIONS | 105 | ||
| 14 -\rNeurologic Dysphagia | 107 | ||
| INTRODUCTION | 107 | ||
| COMMON NEUROLOGIC DYSPHAGIA CONDITIONS | 107 | ||
| Neurodegenerative Disease | 107 | ||
| Muscular Dystrophy | 108 | ||
| Myasthenia Gravis | 108 | ||
| Multiple Sclerosis | 109 | ||
| Amyotrophic Lateral Sclerosis | 110 | ||
| Parkinson's Disease | 110 | ||
| Advanced Dementia | 110 | ||
| Dysphagia in Stroke | 112 | ||
| TREATMENT OPTIONS FOR GLOBAL LARYNGEAL DYSFUNCTION | 113 | ||
| CONCLUSIONS | 113 | ||
| REFERENCES | 113 | ||
| 15 -\rChemoradiation-Induced Dysphagia | 115 | ||
| INTRODUCTION | 115 | ||
| PATHOPHYSIOLOGY OF DYSFUNCTION | 115 | ||
| SYMPTOMS | 116 | ||
| DIAGNOSIS/EVALUATION | 116 | ||
| TREATMENT | 117 | ||
| SUMMARY | 121 | ||
| REFERENCES | 121 | ||
| 16 -\rEpiglottic Dysfunction | 123 | ||
| INTRODUCTION | 123 | ||
| PATHOPHYSIOLOGY | 123 | ||
| SYMPTOMS | 125 | ||
| DIAGNOSIS | 126 | ||
| TREATMENT | 126 | ||
| CONCLUSION | 127 | ||
| REFERENCES | 127 | ||
| 17 -\rCervical Osteophytes | 129 | ||
| INTRODUCTION | 129 | ||
| PATHOPHYSIOLOGY | 129 | ||
| Isolated Osteophytes | 129 | ||
| Diffuse Idiopathic Skeletal Hyperostosis | 129 | ||
| SYMPTOMS | 130 | ||
| DIAGNOSIS AND CLINICAL EVALUATION | 131 | ||
| Office Endoscopy | 131 | ||
| Flexible Endoscopic Evaluation of Swallowing | 131 | ||
| Modified Barium Swallowing Study | 131 | ||
| Manometry | 132 | ||
| TREATMENT | 132 | ||
| Swallow Therapy | 132 | ||
| Medications | 132 | ||
| Transoral Excision of Osteophytes | 132 | ||
| Partial Epiglottidectomy | 132 | ||
| Transcervical Excision | 133 | ||
| Outcomes of Osteophyte Resection | 134 | ||
| CONCLUSION | 135 | ||
| REFERENCES | 135 | ||
| 18 -\rGlottic Insufficiency | 137 | ||
| INTRODUCTION | 137 | ||
| PATHOPHYSIOLOGY | 137 | ||
| SYMPTOMS | 139 | ||
| DIAGNOSIS/EVALUATION | 139 | ||
| TREATMENT/CASE STUDIES | 139 | ||
| CONCLUSIONS | 140 | ||
| REFERENCES | 141 | ||
| 19 - Cricopharyngeal Dysphagia | 143 | ||
| INTRODUCTION | 143 | ||
| CAUSES OF DYSFUNCTION | 143 | ||
| Gastroesophageal Reflux Disease | 143 | ||
| Radiation Fibrosis | 144 | ||
| Neurogenic and Systemic Illness | 144 | ||
| ASSESSMENT | 144 | ||
| Flexible Endoscopic Evaluation of Swallowing | 144 | ||
| Modified Barium Swallow Study | 144 | ||
| Barium Esophagram | 145 | ||
| Transnasal Esophagoscopy | 146 | ||
| High-Resolution Manometry | 146 | ||
| TREATMENT | 146 | ||
| Botulinum Toxin Injection | 146 | ||
| Dilation | 147 | ||
| Myotomy | 147 | ||
| CASES | 148 | ||
| Case 1 | 148 | ||
| Case 2 | 149 | ||
| REFERENCES | 150 | ||
| 20 - Zenker's Diverticulum | 153 | ||
| INTRODUCTION | 153 | ||
| PATHOPHYSIOLOGY | 153 | ||
| SYMPTOMS/PRESENTATION | 154 | ||
| DIAGNOSIS | 154 | ||
| MANAGEMENT | 154 | ||
| The Transoral Rigid Endoscopic Technique | 155 | ||
| Flexible Endoscopic Technique | 157 | ||
| Open (External) Technique | 158 | ||
| How to Manage the Diverticulum | 158 | ||
| Comparing the Options Within Open Surgery | 158 | ||
| Comparing Open Surgery to Endoscopic | 159 | ||
| NOVEL MODALITIES | 159 | ||
| CONCLUSION | 160 | ||
| REFERENCES | 160 | ||
| 21 - Dysphagia Following Laryngectomy | 163 | ||
| OVERVIEW | 163 | ||
| Surgical Management of Laryngeal Cancer | 163 | ||
| Partial Laryngectomy and Swallowing | 164 | ||
| Total Laryngectomy and Swallowing | 165 | ||
| TREATMENT OF DYSPHAGIA FOLLOWING LARYNGECTOMY | 166 | ||
| Behavioral Treatment | 167 | ||
| Surgical Treatment | 168 | ||
| SUMMARY | 169 | ||
| REFERENCES | 169 | ||
| 22 - Esophageal Dysphagia | 173 | ||
| INTRODUCTION | 173 | ||
| PATHOPHYSIOLOGY | 173 | ||
| Esophageal Dysmotility | 173 | ||
| Infiltrative and Systemic Causes | 174 | ||
| Benign Mechanical Causes | 174 | ||
| Malignant Mechanical Causes | 176 | ||
| SYMPTOMS | 177 | ||
| DIAGNOSIS/EVALUATION | 177 | ||
| TREATMENT | 178 | ||
| CONCLUSIONS | 182 | ||
| REFERENCES | 182 | ||
| 23 - Eosinophilic Esophagitis | 185 | ||
| INTRODUCTION/HISTORICAL BACKGROUND | 185 | ||
| EPIDEMIOLOGY AND PATHOPHYSIOLOGY | 185 | ||
| SYMPTOMS | 185 | ||
| DIAGNOSIS/EVALUATION | 186 | ||
| TREATMENT | 187 | ||
| Proton pump inhibitors | 187 | ||
| Topical Corticosteroids | 187 | ||
| Dietary Therapy | 188 | ||
| Esophageal Dilation | 188 | ||
| Choice of Therapy | 189 | ||
| REFERENCES | 189 | ||
| 24 - Swallowing Therapy | 193 | ||
| INTRODUCTION | 193 | ||
| SWALLOW THERAPY CANDIDACY | 193 | ||
| BARRIERS TO SWALLOW THERAPY NOT DIRECTLY RELATED TO A PATIENT'S DYSPHAGIA | 194 | ||
| FURTHER CONSIDERATIONS FOR SWALLOWING THERAPY | 194 | ||
| Should the Patient Swallow Liquid or Food During Therapy? | 194 | ||
| Rehabilitative Versus Compensatory Techniques | 195 | ||
| COMMONLY PERFORMED REHABILITATIVE EXERCISES | 195 | ||
| Exercises Designed to Impact Oral Structures | 195 | ||
| Trismus therapy | 195 | ||
| Tongue press | 195 | ||
| Exercises Designed to Improve the Pharyngeal Swallow | 195 | ||
| Effortful swallow | 195 | ||
| Mendelsohn maneuver | 195 | ||
| Masako maneuver | 196 | ||
| Shaker head lift | 196 | ||
| Chin tuck against resistance | 196 | ||
| Tongue press | 196 | ||
| Expiratory muscle strength training | 196 | ||
| Thermal-tactile stimulation and sensory-motor integration | 196 | ||
| BIOFEEDBACK | 197 | ||
| ELECTRICAL STIMULATION | 197 | ||
| COMPENSATORY TECHNIQUES | 197 | ||
| Head Postures | 197 | ||
| Lower Airway Protective Maneuvers | 198 | ||
| Supraglottic Swallow | 198 | ||
| Super-Supraglottic Swallow | 198 | ||
| Bolus Clearance Maneuvers | 198 | ||
| CONCLUSION | 198 | ||
| REFERENCES | 198 | ||
| 25 - Future Directions in Dysphagia Treatment | 201 | ||
| INTRODUCTION | 201 | ||
| ASSESSMENT | 201 | ||
| PREVENTION | 202 | ||
| BIOINFORMATICS | 202 | ||
| PHARMACEUTICALS | 202 | ||
| SURGICAL TECHNIQUES | 202 | ||
| NEUROSTIMULATION | 203 | ||
| REGENERATIVE MEDICINE | 203 | ||
| CONCLUSIONS | 204 | ||
| REFERENCES | 204 | ||
| Index | 207 | ||
| A | 207 | ||
| B | 207 | ||
| C | 207 | ||
| D | 208 | ||
| E | 209 | ||
| F | 209 | ||
| G | 210 | ||
| H | 210 | ||
| I | 210 | ||
| J | 210 | ||
| K | 210 | ||
| L | 210 | ||
| M | 211 | ||
| N | 211 | ||
| O | 211 | ||
| P | 212 | ||
| Q | 212 | ||
| R | 212 | ||
| S | 212 | ||
| T | 213 | ||
| U | 214 | ||
| V | 214 | ||
| W | 214 | ||
| X | 214 | ||
| Z | 214 |