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![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Role of screening for Dysphagia in stroke patient for NDB
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Tariq Janjua, Doctor Neurovascular Institute, Saint Paul, N, Bernard R. Garon, MS, CCC/SLP and Tariq Janjua, MD, FCCP
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tmjanjua{at}healtheast.org Tariq Janjua, et al.
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We read with interest the article by Martinez-Garcia et al (Feb. 2006)1 . There were several questions and we want to direct the attention to the evaluation of dysphagia in stroke patients with NDB. If the core variable in this study is the “role of dysphagia”, we feel that the authors’ definition for dysphagia is extremely non-defined. Dysphagia is defined as a dysfunction of the oral, pharyngeal and esophageal phase of the swallow, resulting in the inability to swallow or aspiration or laryngeal penetration of intake.2 This study did not evidence that a formal examination of the swallow function e.g. a videofluoroscopic evaluation by a qualified swallow professional was completed. There is no definitive evidence that any of the 30 dysphagia patients were formally examined. There is no data or information regarding the patients’ speech or tongue control, e.g. is there an apraxic or dysarthric component? as tongue strength and ability to form and move a bolus anterior to posterior is a key to a safe swallow.3 “Manifest incapacity to swallow solids or liquids” is undefined. “ Oral dribbing after administering 10 ml of water” is only indication of possible 7th cranial nerve involvement with lip closure which does not cause dysphagia or aspiration to occur. “ Repetitive cough” may be related to intubation irritation of the pharynx. “Laryngeal involvement”- lack of laryngeal elevation during the swallow is often related to swallow dysfunction, but many people with good laryngeal elevation aspirate on our examination. “Palatal elevation” ( the 10th cranial nerve) can be better assessed on a video to assess complete closure during the swallow. The “nausea reflex” probably referred to the gag reflex, can be indicative of a dysphagia problem, but many normal people do not have a gag reflex conversely people without a gag reflex can swallow well. We feel that if the authors are going to apply the key variable of dysphagia to check for the NDB, then they should have first proved that dysphagia existed and was verified by a swallow professional. References: 1.Martinez-Garcia MA, Galiano-Blancart R, Solar-Catauna JJ, Cabero- Salt L, Roman-Sanchez P. Improvement in Nocturnal Disordered Breathing after First –Ever Ischemic Stroke. Role of Dysphagia. Chest 2006;129:238- 245 2.Logemann JA: Evaluation and Treatment o Swallowing Disorders. San Diego, CA: College-Hill Press, 1983, Page 3 3.Garon BR, Ormiston C et al Dysphagia 2002;17:57-68 |
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