Day1 1115-1215 Goudy-dysphagia-2014...Case 1 • Exam findings include: – Hoarse voice – Upper...
Transcript of Day1 1115-1215 Goudy-dysphagia-2014...Case 1 • Exam findings include: – Hoarse voice – Upper...
Dysphagia Panel
Gwen Provo‐Bell and Steven Goudy Pediatric Otolaryngology
Vanderbilt University Medical Center
Disclosure
• I have nothing to disclose
Case 1
• 10 yo with history of neuroblastoma spresection and xrt 6 years ago
• Upper and lower motor weakness• Admitted to PICU for recurrent PNA with 6 in the last year
Case 1
• Exam findings include:– Hoarse voice– Upper and lower motor weakness– Tongue fasiculations
• Next step?– Bedside swallow study– Videofluoro swallow study– Flexible endoscopic evaluation of swallowing
Case 2
• 6 yo with history of cardiac transplant• Ongoing coughing with oral feeding• Hoarse and breathy voice• Intermittent pneumonia • No history of GERD
Case 2
• Flexible bedside evaluation demonstrates immobile left TVC
• Next Steps?– Observation?– Injection medialization?
• Gelfoam• Cymetra• HA
– Nerve reinnervation?
Case 3
• 5 yo with bilateral vocal cord paralysis• Sp endoscopic posterior graft• Post‐operatively has significant pain and dysphgia
• Next step?– Videoswallow– Beside swallow– FEES
Case 4
• 10 month old with ongoing cough• Recurrent pneumonia • Always sounds “sick”• What to order?
– Bedside evaluation– FEES– VFSS