Swallowing disorders in closed head trauma patients

Area of Science:

• Neurology
• Gastroenterology
• Speech-Language Pathology

Background:

• Dysphagia is a common complication following closed head trauma (CHT).
• Accurate assessment of swallowing disorders is essential for patient management and preventing aspiration.
• Traditional bedside swallowing evaluations have limitations in assessing the pharyngeal phase.

Purpose of the Study:

• To videofluorographically characterize the specific swallowing disorders in patients with CHT.
• To identify the prevalence of various oropharyngeal motility dysfunctions.
• To determine the relationship between specific swallowing impairments and aspiration.

Main Methods:

• Videofluoroscopic swallowing studies (VFSS) were conducted on 53 patients with CHT and dysphagia.
• Analysis focused on the presence and nature of delayed/absent swallowing reflex, tongue control, peristalsis, laryngeal function, and cricopharyngeal dysfunction.
• Aspiration and its etiological factors were identified.

Main Results:

• 81% of patients had a delayed or absent swallowing reflex.
• Reduced tongue control (50%) and peristalsis (33%) were also prevalent.
• Multiple swallowing motility problems were common in CHT patients.
• 20 patients aspirated, most frequently due to delayed/absent swallowing reflex.
• A significant number of aspirating patients lacked a protective cough reflex.

Conclusions:

• CHT frequently results in complex oropharyngeal dysphagia with multiple motility deficits.
• Delayed/absent swallowing reflex is a primary contributor to aspiration in this population.
• Videofluorography is an indispensable tool for diagnosing CHT-related dysphagia and aspiration, especially given the limitations of bedside assessments.