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The definitive educational guide on the diagnosis and management of dysphagia across the full age continuumDysphagia presentation and treatment differs at various stages of life. Assessing and Treating Dysphagia: A Lifespan Perspective reflects significant knowledge and pearls from esteemed adult and pediatric swallowing disorders experts. Debra Suiter and Memorie Gosa have compiled a book of unique depth and breadth with contributions from communication science experts including speech-language pathologists and physicians. The textbook provides comprehensive coverage of swallowing disorders from birth to old age, including clinical, professional, and cultural ethical considerations.Key HighlightsAnatomy and physiology of swallowing, and compensatory, postural, and rehabilitation strategiesAdult and pediatric specific chapters on swallow screenings, clinical evaluations, and technologies such as videofluroscopic, fiberoptic endoscopic, and high-resolution manometryPediatric-specific dysphagia related to premature birth, craniofacial syndromes, congenital heart disease, and cerebral palsyAdult-specific dysphagia related to neurodegenerative disease, stroke, traumatic brain injury, head and neck cancer, esophageal disease, pulmonary disease, and end of lifeThis is the only textbook on the market featuring complete coverage of the diagnosis and management of dysphasia across the lifespan. With content following Master's-level course curriculum, this is essential reading for graduate students as well as practicing clinicians in the fields of otolaryngology and speech language pathology.This book includes complimentary access to a digital copy on https://medone.thieme.com.
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Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Univariate and multivariable analyses were performed to examine the relationship between laryngeal sensation, length of intubation, and aspiration. Secondary outcomes included pharyngolaryngeal secretions, pneumonia, and diet recommendations. One-hundred and three patients met inclusion criteria. Fifty-one patients demonstrated an absent laryngeal adductor reflex (LAR). Altered laryngeal sensation correlated with the presence of secretions (p = 0.004). There was a significant interaction between the LAR, aspiration, and duration of mechanical ventilation. Altered laryngeal sensation was significantly associated with aspiration on FEES only in patients with a shorter length of intubation (p = 0.008). Patients with altered laryngeal sensation were prescribed significantly more restricted liquid (p = 0.03) and solid (p = 0.001) diets. No relationship was found between laryngeal sensation and pneumonia. There is a high prevalence of laryngeal sensory deficits in mechanically ventilated patients post-extubation. Altered laryngeal sensation was associated with secretions, aspiration, and modified diet recommendations especially in those patients with a shorter length of mechanical ventilation. These results demonstrate that laryngeal sensory abnormalities impact the development of post-extubation dysphagia.
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BACKGROUND: Post-extubation dysphagia is associated with an increased incidence of nosocomial pneumonias, longer hospitalizations, and higher re-intubation rates. The purpose of this study was to determine if it is necessary to delay swallow evaluation for 24 hours post-extubation., METHODS: A prospective investigation of swallowing was conducted at 1, 4, and 24 hours post-extubation to determine if it is necessary to delay swallow evaluation following intubation. Participants were 202 adults from 5 different intensive care units (ICU)., RESULTS: A total of 166 of 202 (82.2%) passed the Yale Swallow Protocol at 1 hour post-extubation, with an additional 11 (177/202; 87.6%) at 4 hours, and 8 more (185/202; 91.6%) at 24 hours. Only intubation duration >=4 days was significantly associated with nonfunctional swallowing., CONCLUSIONS: We found it is not necessary to delay assessment of swallowing in individuals who are post-extubation. Specifically, the majority of patients in our study (82.2%) passed a swallow screening at 1 hour post-extubation.