I FINALLY received the video swallow study report that Emma had done on the 3rd. I've got questions that I hope someone more knowledgeable than I can answer:

1. The oral stage was mildly impaired. Patient had difficulty in the following areas: yet, it didn't list anything?

2. The pharyngeal stage was moderately impaired. the patient had difficulty in the following areas: Reduced laryngeal closure.

3. Vestibular and tracheal aspiration occurred during the study. When aspiration occurred, approx 1% of the bolus tested was aspirated.

4. Laryngeal sensitivity was poor.

5. Response to therapeutic techniques was fair. (not sure what therapeutic techniques were done)

6. Suck swallow ration ranged betwee 1:-2:1 demonstrated increased OTT with some presentations and piecemeal deglutition

7. Recommend ENT d/t decreased laryngeal sensitivity w/aspirations.

8. Tracheal lining was noted w/thins (I'm assuming the liquid)

9. No protective cough present w/aspirations or deep penetrations (of what?...what penetrated?)

I know that this is a lot to ask, but at least I now know that she does have dysphagia...the GI stated that we will discuss the report in detail at her next appt 12/5. Any help is appreciated!

Hi Jane:

I responded to your thread with great detail 2 days ago, but the thread “timed out” and lost my responses L. I have learned my lesson and will now pre-type my responses and SAVE them…lol! Here we go with take # 2:


A mildly impaired oral stage can mean many things. You want to know if there was anterior spillage (did she lose liquid around the nipple/cup seal), decreased anterior to posterior lingual peristalsis (did her tongue move in a wave-like motion), was she able to prepare and control a bolus (liquid or food amount), did she use her tongue to lateralize food, was her oral swallowing phase uncoordinated or dysfunctional, etc.
A moderately impaired pharyngeal stage can look at many things as well. When we look at “reduced laryngeal closure,” this typically means aspiration (anything foreign in the trachea or windpipe). How often did this occur and did it occur before, during, or after the swallow? Was there swallow delay (to the valleculae, to the pyriform sinuses, or both)? Was there nasopharyngeal reflux? Was there good velar elevation with the swallow? Was there residue following the swallow and if so, where?
Was the aspirate amount mild, moderate, or significant in volume and did it go to the anterior or posterior tracheal wall (or both)? Was it on thin liquids or slightly thickened liquids? What did they use to thicken the liquids with during the study? Simply Thick, Thick It, rice cereal, oatmeal, gelatin, etc.? Refer to # 2 for questions regarding the aspiration.
How did they assess laryngeal sensitivity and how do they know it was poor? What techniques did they use?????
Refer to question # 4.
Normal SSB (suck swallow breathe) coordination has a 1:1:1 ratio. I would ask for a better clarification on the -2.
Was an ENT present or are they recommending that an ENT assess the larynx with endoscopy? Get clarification.
The tracheal lining I assume had thin liquid residue from the aspirated material. Again, was it mild, moderate, or significant and was it on the anterior or posterior aspect of the trachea?
I, personally, have not ever seen a patient cough from deep penetration. Penetration is when liquid or food penetrates (darts into) the trachea or airway below the vocal folds, but then darts back out and does not stay in the airway as aspiration. However, it is typically a precursor for aspiration if it occurs on a frequent basis. When aspiration does occur, you want the patient to cough. Coughing is a protective mechanism that can rid the airway of the foreign matter and protect the patient from getting sick (i.e. upper respiratory infections, pneumonias). Emma did not cough, she “silently” aspirated.
I hope this helps you. Please write back with questions. Happy holidays to you and your family J
Robynne

Thank you so much! I will be calling the speech pathologist's office on Monday and will also bring up some of this to the GI when she plans on discussing the report with me on 12/5.

I had a gut feel that this report was not as detailed as it may have been (plus I had numerous problems with them at the study...they were the ones that referred me to the ENT without consultation of my GI doc)

If and when I receive the answers, I will update ...

The points that you brought up were very good and I can honestly say that with those answers, the report may have made more sense.

Thank you again!!