[Dysphagia - epidemiology, diagnostics, therapy and nutrition-management]

Swallowing is a complex neuro-muscular process at which around 50 muscle couples need to be coordinated. The swallowing process is controlled by the swallowing centres in cortex and brainstem as well as by five brain nerves.

Severe dysphagia appears most frequently in the context of neurological illnesses. Particularly in patients with acute stroke, swallowing disorders are reported in up to 50% of cases.

The main emphases must be put on the case history, a swallowing specific physical examination, a "Swallowing Screening Test" and the use of technical examination methods, like the flexible laryngoscopy as well as the video-fluoroscopy. It is of special importance to identify "silente aspiration" which can only be verified by the use of technical examination methods.

It should always be carried out interdisciplinarily. Besides a restitutive and a compensatory therapy also an ADAPTATIVE THERAPY have to be applied. The duration of therapy needed depends on severity of dysphagia and can be accounted to 2.5 months on average. nutrition-management: All measures should be targeted at avoiding weight loss and malnutrition. The oral feeding should be started early, however in a controlled fashion and has to be carried out by the use of a diet that is adapted to the swallowing disorders.

Dysphagia is a clinical relevant problem in known risk patients. To avoid "silent aspiration" disinguished and routinely established diagnostic processes as well straight therapeutic approaches are needed. These approaches need to be done by highly trained and clinically experienced stuff members who cooperate interdisciplinary and multiprofessional.