Evaluation and management of adult dysphagia and aspiration

Abstract

This paper reviews the current state of dysphagia management, including evaluation and treatment of swallowing disorders arising from neurologic disorders and surgical interventions. The modified barium swallow and the flexible endoscopic assessment of swallowing are the two most common instrumental evaluations of swallowing, although other tests, such as scintigraphy and pulse oximetry, are also discussed. Although current evaluative methods rely on instrumental tests, the efficacy of dysphagia testing remains controversial, as this paper points out. New treatments, or modifications of previous techniques, for swallowing disorders include the use of botulinum toxin, pharmacologic approaches, modification of bolus consistencies, and surgeries to improve vocal fold closure. In addition, behavioral techniques, such as thermal stimulation, maneuvers to increase bolus propulsion, and postural techniques are reviewed. Although most reports indicate the positive effects of treatment, controlled prospective studies to suggest the amount of treatment and the best time to initiate treatments are sparse. The discipline of dysphagia continues to evolve; however, definitive diagnostic and treatment protocols remain to be determined for many swallowing disorders. © 2000 Lippincott Williams & Wilkins, Inc.