Swallowing dysfunction

In developed countries, ablative procedures have largely been replaced by DBS, because the latter are equally effective or somewhat superior to ablation, are less invasive, and are reversible and adjustable. In addition, bilateral pallidal lesions have an increased risk of causing speech and swallowing dysfunction, while bilateral DBS procedures can be done without significantly increased risk. However, the stimulators require battery replacements, are prone to mechanical lead difficulties and sometimes require frequent adjustment of stimulation parameters. 

Ebihara, T., Ebihara, S., Maruyama, M. et al. 2006a. A randomised bial of olfactory stimulation using black pepper oil in older people with swallowing dysfunction.. 7. Am. Geriatr. Soc. 54 1401-1406. 

At our facility, the Temple University Hospital, which is one of four HCFA Chronic Ventilator-Demonstration sites, the complex and diverse problems of PMV patients are treated by a diverse team comprises pulmonologists, respiratory nurses, nutritionists, psychologists, physical therapists, speech therapists, and a social worker (Fig. 2). This unit emphasizes rehabilitation and restoration of functional status despite requirements for prolonged ventilation. Special needs of patients that require PMV addressed in this unit include evaluation of the optimum form of ventilator support, special attention to swallowing dysfunction, impaired communication skills, psychological dysfunction, nutritional repletion, respiratory muscle and whole body reconditioning, as well as close attention to new or changing medical conditions. 

Tolep K, Getch KL, Criner GJ. Swallowing dysfunction in patients requiring prolonged... 

Bonanno PC. Swallowing dysfunction after tracheostomy. Ann Surg 1971 174 29-33. 

Botulism. Clinical features include symmetric cranial neuropathies (i.e., drooping eyelids, weakened jaw clench, and difficulty swallowing or speaking), blurred vision or diplopia, symmetric descending weakness in a proximal to distal pattern, and respiratory dysfunction from respiratory muscle paralysis or upper airway obstruction without sensory deficits. Inhalational botulism would have a similar clinical presentation as food-borne botulism however, the gastrointestinal symptoms that accompany foodborne botulism may be absent. 

Grinstein, S., Swallow, C. J., Rotstein, O. D. (1991). Regulation of cytoplasmic pH in phagocytic cell function and dysfunction. Clin. Biochem. 24, 241-7. 

Amyotrophic lateral sclerosis. One hundred thirty one respondents with amyotrophic lateral sclerosis—13 of whom reported using cannabis in the last 12 months—were examined. The results indicated that cannabis might be moderately effective at reducing symptoms of appetite loss, depression, pain, spasticity, and drooling. Cannabis was reported ineffective in reducing difficulties with speech and swallowing, and sexual dysfunction. The longest relief was reported for depression (approx 2-3 hours... 

Dosage Tablets 100 and 200 mg strengths. Adults initially 200 mg each a.m., may increase to 400 mg each a.m., if needed (begin with 100 mg each a.m. if have severe liver dysfunction). Not approved for use in ohildren under sixteen years old. Extended release capsules. May be swallowed whole, or beads may be sprinkled on applesauce and swallowed immediately do not chew, crush, or cut beads. 5,10,15,20 mg strengths. Adults initially 10 mg each a.m., may increase to 20 mg each a.m. after 1 week, if needed. 

Along with hypoventilation, these alterations represent the most important problem from the patient s point of view (29). Severe bulbar dysfimetion and glottie dysfunction most commonly occur in patients with amyotrophie lateral selerosis (ALS), spinal muscle atrophy type 1, and the pseudobulbar palsy of eentral nervous system etiology (30). Inability to elose the glottis and vocal cords results in eomplete loss of the ability to cough and swallow. 

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