[The management of swallowing disorders through rehabilitation methods]

Swallowing disorders are commonly encountered in ENT practice, and dysphagia may present a challenge with respect to diagnosis and management. This study aimed to examine patients with swallowing disorders.

The study included 280 patients (153 males, 127 females; mean age 53 years; range 3-98 years) who presented with complaints of swallowing difficulties between October 2000 and June 2002. The patients were examined according to the protocol of our department for swallowing disorders, which involved a detailed history taking, a patient questionnaire on swallowing disorders, cervical auscultation, and modified barium swallow studies. When further investigation was needed, fiber-optic endoscopic swallow studies, ultrasonic evaluation of the tongue base, neck CT, and 24-hour double-probe pH monitoring were also undertaken.

A diagnosis of a swallowing disorder (premature spills, pulling in the vallecula and/or pyriform sinuses, penetration and/or aspiration, and delayed swallow reflex) was made in 164 patients. Dysphagia arose from a mechanical cause in 55%, and from a neurological cause in 32%. A multiphase rehabilitation program was initiated, which included positioning, adjusting bolus consistency, oral-motor range of motion exercises, use of palatal devices and swallowing techniques. Rehabilitation resulted in normal swallowing in 128 patients (78%).

Mechanical causes should also be sought in patients with swallowing disorders.