Case 2

History

• 86 yr old female with Dementia.
• Coughs with oral intake and has a diagnosis of right lower lobe pneumonia.

Radiographic Findings

• Poor tongue strenth and diminished oral sensation
  • Incomplete tongue to palate seal with poor oral bolus containment
    • Diffused spreading of bolus to lateral sulci and floor of mouth
  • Premature entry of bolus head into pharynx
    • Laryngeal vestibular penetration prior to pharyngeal swallow.
  • Delayed initiation of pharyngeal swallow
    • Delayed laryngeal closure
      • Laryngeal vestibular penetration
  • Diffuse oral residue
• Decreased hyolaryngeal excursion
  • Pryiform residue
  • Post swallow aspiration
• Decreased tongue base retraction
  • Vallecular residue
    • Post swallow aspiration
• Diminished glottic and subglottic sensation
  • No attempt to clear aspirated material

Treatment

• Supervised feedings of 3-5 cc boluses of purees
  • Facilitate oral control
  • pharyngeal clearance
  • prevention of aspiration
• NPO with PEG
  • Prevent aspiration and meet nutrition/hydration needs
• Double swallow
  • Improve oropharyngeal clearance

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