Page 88 - Portuguese Journal - SPORL - Vol 61. Nº2
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of patients into several therapeutic categories: However, this method has limitations
1) patients with mild symptoms who require regarding the assessment of the pharyngeal
strategies mainly based on reducing the and esophageal phases.
volume of the bolus and increasing its viscosity; The two procedures complement each
2) patients with severe symptoms who also other. They are both used in older patients
need postural changes, increased sensory to determine the pattern or nature of the
information, and swallowing maneuvers; 3) problem, test behavioral strategies, and
patients with severe dysphagia in whom oral detect changes in the volume and rheological
feeding is contraindicated and who need an characteristics of the bolus and their effects
alternative feeding method . on swallowing. Therefore, they are considered
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“therapeutic” tests.
Endoscopic Evaluation of Swallowing Obviously, during instrumental evaluation, the
Fiberoptic endoscopy of swallowing swallowing parameters should be interpreted
(FEES) allows the visualization of the differently when comparing young and older
laryngopharyngeal dynamics during adults. In addition to the changes in the oral,
the swallowing of differently dyed food pharyngeal, and esophageal phases previously
consistencies. The two main objectives are described and visible on VFC and FEES,
as follows: (1) contribute to the diagnosis of findings such as the whiteout phenomenon
the unknown underlying disease of OPD; (moment of bolus transfer and movement of
(2) prescribe/outline a treatment and/or the pharyngeal structures during swallowing
therapeutic plan for OPD . that are not visible due to the reflection
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The main advantages of this evaluation are as of light from the fiberoptic endoscope on
follows: (i) it can be performed at the bedside; the laryngopharyngeal tissues) are more
(ii) there is no duration limit due to the prolonged in older adults. Butler, Maslan, et al.
absence of radiation; (iii) it allows biofeedback reported that the bolus remains for a longer
so that patients and carers can understand time in the valleculae and pyriform sinuses
the functional changes and impact of the of healthy older adults aged 70–90 years and
suggested adaptations and compensations that this dwelling time increases with age .
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on the function.
It is a useful tool for the detection of premature Intervention
and/or late leakage into the laryngeal The main goal of the interventions for
vestibule, presence of laryngopharyngeal dysphagia is to reduce the morbidity and
residues, penetration, and aspiration. These mortality associated with respiratory infections
findings allow the classification of the severity and poor nutritional status by promoting safe
of dysphagia. and adequate nutrition and hydration with
Premature leakage involves the transfer of the minimal complications. Its aim is to recover
bolus to the pharynx before the swallowing physiological swallowing and maintain the
reflex is triggered and is usually the result of patient’s quality of life as much as possible. In
deficient or incomplete glossopalatal closure. terms of rehabilitation, exercise may play a role
Pharyngeal residues are usually the result of in reducing the risk of aspiration. However, we
deficient bolus transfer from the mouth to the emphasize that not all changes in the muscle
stomach. mass have an impact on swallowing, although
Penetration/aspiration generally results from muscle strengthening exercises, namely of
deficient closure of the airway, and its etiology the muscles involved in swallowing in older
varies. Its timing (before, during, or after adults, may reduce the risk of developing
swallowing) and the penetrated/aspirated dysphagia .
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amount are important findings for the The compensatory strategies for dysphagia
classification of the dysphagia phenotype . involve diet and/or behavioral modifications.
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230 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
