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Dysphagia associated with cricopharyngeal dysfunction
Archives of Physical Medicine and Rehabilitation
|August 1, 1979
Summary
Dysphagia management for neuromuscular dysfunction can be improved with speech therapy. Conservative treatments, including dietary modifications and swallowing exercises, helped patients avoid cricopharyngeal myotomy.
Area of Science:
- Neurology
- Gastroenterology
- Speech Pathology
Background:
- Protracted dysphagia from neuromuscular dysfunction often leads to considering upper esophageal sphincter myotomy.
- Indications and outcomes for cricopharyngeal myotomy remain unclear in medical literature.
Observation:
- Three cases of dysphagia due to cricopharyngeal sphincter dysfunction post-neurological events (brain stem infarctions, inflammatory disease) were analyzed.
- Barium swallow revealed aspiration and cricopharyngeal sphincter non-relaxation; indirect laryngoscopy showed vocal cord paralysis.
- Speech pathology evaluation found no oral musculature abnormalities, and one patient had normal laryngeal EMG.
Findings:
- All patients initially required gastrostomies for nutritional support due to severe dysphagia and aspiration.
- Targeted therapeutic modifications, including food consistency, rate, quantity, and aspiration prevention counseling, were implemented.
- Successful oral feeding without aspiration was achieved in all three patients within the treatment period.
Implications:
- Conservative management, including speech therapy and dietary adjustments, can be effective in treating dysphagia associated with cricopharyngeal dysfunction.
- Cricopharyngeal myotomy may not be necessary for all patients with long-standing swallowing difficulties, even with apparent neuromuscular deficits.
- This study highlights the potential for non-surgical interventions to restore safe oral feeding and obviate the need for surgical procedures.