Otolaryngol Clin North Am

Anatomy and physiology of pediatric swallowing disorders.

Year 1998
Derkay CS. Schechter GL.
Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.
The anatomy and physiology of the act of swallowing is complex. Because the swallowing mechanism matures with age, it is important to understand this maturation process from neonate to older child to appreciate the impact of this changing physiology on pediatric swallowing disorders. This article reviews the relevant anatomy, neurologic control mechanism, and physiology of swallowing in neonates and children.

Evaluation of swallowing disorders in children.

Year 1998
Darrow DH. Harley CM.
Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Congenital anomalies of the head and neck and congenital and acquired neuromuscular disorders in children are frequently associated with dysfunctional feeding and swallowing. Determination of the affected phase of swallowing and appropriate guidelines for feeding depend on detailed clinical assessment at the bedside and radiographic evaluation by videofluoroscopy. Fiberoptic and rigid endoscopic examination of the airway are useful in the diagnosis of subtle structural abnormalities that are not appreciated on physical and radiologic examination. Once a diagnosis is established, repeating the evaluation process helps to assess the outcome of therapeutic and surgical intervention.

Gastroesophageal reflux in children.

Year 1998
Tsou VM. Bishop PR.
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA.
Gastroesophageal reflux (GER) is a common disorder in infants and children with a high rate of spontaneous resolution. Some children, however, will continue to have problems and progress from functional GER to pathogenic GER. In children with functional GER, diagnostic testing and pharmacologic treatment is unnecessary. In more involved cases, there are a number of tests available that help to quantify and qualify the extent of disease. Treatment begins with conservative measures and progresses to acid neutralization/supression and medications to enhance motility. Should medical management fail to control the consequences of reflux disease, surgical intervention is warranted.

Differential diagnosis of dysphagia in children.

Year 1998
Kosko JR. Moser JD. Erhart N. Tunkel DE.
Division of Pediatric Otolaryngology, Nemours Children's Clinic, Orlando, Florida, USA.
Dysphagia in children often presents a difficult diagnostic challenge. A systematic approach in each individual can help with diagnosis and treatment. An overview of the differential diagnosis and the diagnostic and treatment options available is provided.

Management of pediatric dysphagia.

Year 1998
Arvedson JC.
Speech-Language-Hearing Department, Children's Hospital of Buffalo, Buffalo, New York, USA.
Decisions for management of feeding and swallowing problems in infants and children are likely to be most effective in a professional team approach with caregivers. Optimal management relies on optimal assessment. This article focuses on management strategies that involve "food rules," the position and posture changes, alterations in food and liquid attributes, oral-motor and swallow function, utensil changes, adjustments in feeding schedules and pacing, and behavioral intervention with failure to thrive in the context of global issues for children who are oral and nonoral feeders.

Anatomy and physiology of swallowing in adults and geriatrics.

Year 1998
Plant RL.
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Key anatomic and physiologic features that play an important role in normal and abnormal swallowing in the adult are described. Highlighted topics include the neurologic afferent and efferent control mechanisms, the effect of stroke on these mechanisms, and the upper and lower esophageal sphincters.

Contemporary diagnosis of the dysphagic patient.

Year 1998
Bastian RW.
Department of Otolaryngology, Loyola University Chicago, Maywood, Illinois, USA.
A variety of tests are available to aid in the diagnosis and management of dysphagia. In this article the advantages and disadvantages of many of these tests are described. Special attention is given to the videoendoscopic swallowing study (VESS). An overall treatment plan is described.

Dysphagia caused by neurologic deficits.

Year 1998
Dray TG. Hillel AD. Miller RM.
Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA.
This article provides a brief review of the neurophysiology behind the normal swallow. The examination and work-up of a patient with dysphagia is then detailed. Finally, the major neurologic conditions associated with dysphagia are considered.

Systemic causes of dysphagia in adults.

Year 1998
Schechter GL.
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Dysphagia is associated with many systemic disorders. This article presents information that can be used to assist with developing a differential diagnosis in patients who have dyshpagia without an obvious localized cause. The essentials of the history, physical examination, endoscopy, and special tests are outlined.

Surgical therapy for swallowing disorders.

Year 1998
Wisdom G. Blitzer A.
Department of Otolaryngology-Head and Neck Surgery, St. Luke's-Roosevelt Hospital, New York, New York, USA.
In a physiologic act as complex as swallowing, there are myriad causes of dysfunction that can disorder feeding and respiration with grave consequences. The appropriate diagnostic evaluation of dysphagia and aspiration along with a review of a range of surgical strategies to correct swallowing and aspiration disorders are presented in this article.

Swallowing therapy in adults.

Year 1998
Poertner LC. Coleman RF.
Virginia Beach General Hospital, Virginia Beach, Virginia, USA.
Swallowing therapy can in many cases eliminate, and in nearly all cases, improve swallowing difficulty in adults. A wide variety of faciliatory and compensatory techniques are available to therapists who must be specially trained in such methods. In addition, swallowing therapy cannot be thought of as a series of "lessons" for a patient, but rather a management strategy using a multidisciplinary team, including the family of the patient. Efficacy studies are becoming available to evaluate the effectiveness of the many therapy methods available, and new techniques are constantly being developed and tested. The outlook for most adults with swallowing problems is thus optimistic for improvement.