Swallowing is a complex physiological process, and several conditions can interfere with this process. Dysphagia and swallowing problems are common and can occur in any age group interfering with routines of eating and drinking that can normally be taken for granted. There are many causes though neurological, structural damages and head and neck cancers are common causes of swallowing disorders.
Patients are referred to the swallowing disorders centre to undergo assessment of their swallowing for identification, management and treatment of dysphagia. Imaging methods such as videofluoroscopy and endoscopic examination could also be undertaken if indicated. Management of the swallowing disorder is done through counselling the patient and caregivers of techniques to follow while feeding and surgical intervention if necessary.
Research shows that about 5% of general population have dysphagia. One in two head and neck cancer patients suffer from swallowing disorders, while 80% of adults with motor neuron disease and children with cerebral palsy and Down syndrome suffer from the same. Adults with dementia (13 to 57%), parkinson’s disease (35 to 80%), mental illness (32%) and prolonged medical care due to old age (30%) also suffer from dysphagia in a large extent.
Swallowing difficulties impact normal life drastically not only for the patient but even their care givers. It often leads to malnutrition, dehydration and recurrent chest infections. Mortality rates are also significantly high among these patients. Sometimes, patients have recurrent hospital admission and prolonged hospitals stays leading to repeated courses of antibiotics and dependence on feeding tubes, which in turn, increase the financial burden of the families. Notwithstanding its incidence and the influence, it has on so many aspects of daily life as well as on health and wellbeing, swallowing disorders remains undetected and untreated in many medical institutions and residential care home, globally.
The swallowing disorders service at Amrita provides specialist expertise in the assessment and management of complex feeding and swallowing problems. Infants, children and adults who have some degree of neurological impairment, resulting in severe and specific difficulties while eating and drinking can avail this service. Clinical and imaging examinations are done when indicated, the results are then discussed with the family caring for the patient. Further detailed assessments, recommendations, or methods of feeding to be followed are conveyed.
After head and neck cancer treatment, sufficient rehabilitation of the patient with respect to speech and swallowing is required. A dedicated speech and swallowing service which participates in the early rehabilitation of speech and swallowing function of these patients is needed to improve their quality of life and cure. These patients include both those who have undergone surgery and those who have received radiation treatment. Endoscopic and videofluoroscopic evaluation precisely identifies the problem in these patients which can be corrected by rehabilitative techniques.
Swallowing disorders have differing etiologies and involve many systems of the body. Hence, the swallowing service team comprises of a consultant Speech and Language Pathologist specializing in Swallowing Disorders, Otolaryngologist, Head & Neck Surgeon, Pediatric Neurologist, Gastroenterologist, Stroke Medicine Physician and Neurologist. These diverse specialists come together to provide cutting edge advances and diagnosis to patients. This helps to provide comprehensive treatment and care to the patient.
The multidisciplinary approach to treat dysphagia as more than just an assessment and management strategy using videofluoroscopy, manometry and electromyography to a more comprehensive approach by understanding brainstem control mechanism, cortical modulatory effects on deglutition and effects of phagosurgery.
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