What is the next step for a patient who failed a speech therapy evaluation for swallowing (dysphagia)?

From the Guidelines

The next step for a patient who failed a speech therapy evaluation for swallowing (dysphagia) is to undergo instrumental assessments, such as a modified barium swallow study (MBSS) or fiberoptic endoscopic evaluation of swallowing (FEES), as recommended by the most recent guidelines 1.

Key Considerations

• The patient should be monitored for signs of malnutrition or dehydration, as dysphagia can significantly impact nutritional intake.
• Alternative feeding methods, such as nasogastric tubes or percutaneous endoscopic gastrostomy (PEG) tubes, may be considered to ensure adequate nutrition while the underlying swallowing disorder is being addressed.
• Dietary modifications, such as thickened liquids or soft foods, and specific swallowing techniques or postural adjustments during meals, may be recommended by the speech therapist to reduce the risk of aspiration pneumonia.

Instrumental Assessments

• A videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic examination of swallowing (FEES) can provide detailed visualization of the swallowing process and identify the exact nature and location of the swallowing difficulty.
• These assessments can help guide the development of an individualized management plan to address the patient's dysphagia and nutritional needs.

Interdisciplinary Approach

• An interdisciplinary team, including a speech-language pathologist, dietitian, and gastroenterologist, should work together to develop and implement a comprehensive plan for managing the patient's dysphagia and nutritional needs.
• The patient and their caregivers should receive education on swallowing and feeding recommendations, as well as guidance on how to implement these recommendations in daily life.

Prioritizing Patient Safety

• The patient's safety should be the top priority, and all efforts should be made to reduce the risk of aspiration pneumonia and other complications associated with dysphagia.
• Regular monitoring and reassessment of the patient's swallowing abilities and nutritional status are essential to ensure that the management plan is effective and to make any necessary adjustments.

From the Research

Next Steps for Patients who Failed Speech Therapy Evaluation for Swallowing

• A multidisciplinary approach is recommended for the management of dysphagia, involving a team of specialists including speech-language pathologists, gastroenterologists, radiologists, otolaryngologists, neurologists, and others 2.
• The patient should undergo a comprehensive assessment, which may include clinical examination, swallowing videoendoscopy, and other necessary investigations to determine the underlying cause of dysphagia 3.
• The use of fiberoptic endoscopic evaluation of swallowing (FEES) or videoendoscopic swallowing study (VESS) can be an alternative or complementary method to videofluoroscopic swallowing study (VFSS) for assessing swallowing function 4, 5.
• A multidisciplinary dysphagia clinic can provide a comprehensive assessment and management of patients with dysphagia, and otolaryngologists play a critical role in the evaluation of this condition 6.
• Treatment modalities may include dietary modifications, teaching of therapeutic swallowing maneuvers, medical treatment, and surgical treatment, depending on the underlying cause and severity of dysphagia 6.