Archives for April 2014

Motility Disorders in Dysphagia and Dysphonia

Speech Pathologists routinely encounter patients who present with well-defined voice and swallowing disturbances fueled by motility disorders. However, capturing objective information about esophageal function can often be difficult and frustrating for both the patient and the clinician. There are a variety of reasons for this: 1. There are a limited number of Otolaryngologists and Gastroenterologists that specialize in esophageal motility 2. Technology that evaluates these disorders is expensive and requires specialty-trained staff. 3. Motility testing is rarely housed within a dedicated voice and swallowing center which creates a challenge in multidisciplinary collaboration and communication.

Understanding the role of motility disorders in co-existing dysphagia and dysphonia is imperative. The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. The upper and lower most segments are high-pressure sphincters that are tonically contracted at rest and provide protection against back flow of material. When a person swallows, the coordinated muscular contractions of the esophagus propel the food or fluid from the throat to the stomach. If the muscular contractions become disrupted or weak, patients may experience a variety of symptoms. Acid regurgitation may or may not be reported. Patients may come into the speech pathology clinic complaining of chronic, refractory cough, persistent dysphonia and laryngospasm, as of which may be directly fueled or exacerbated by motility disorders.

High resolution manometry is an invaluable tool that allows for detailed evaluation of pressure and motor function within the esophagus and can help in diagnosing complex disorders including: GERD/LPR, Hiatal Hernia, Nutcracker esophagus and Achalasia. pH testing similarly generates objective quantification of reflux events that occur over an extended period of time. Together, these tools provide the SLP with essential information that allows for the most accurate assessment and understanding of complex voice and swallowing disorders. It also allows for sound, mutli-disciplinary treatment planning in order to generate the most ideal clinical outcomes.  -Liza Blumenfeld