| Patient
Services
Swallowing disorders
treated/procedures performed at or through Bastian Voice Institute
Neurological
swallowing disorders
Bastian Voice Institute physicians see patients who
are having difficulty swallowing after stroke, or in the context
of post-surgical paralysis of palate, pharynx (throat part
of the swallowing passage), and larynx. In collaboration with
speech pathology colleagues at nearby Good Samaritan Hospital,
detailed assessment of neurological, structural, and functional
deficits allows the establishment of a detailed plan of remediation.
Primary modalities used for evaluation include not only the
history and general examination of the mouth, throat, and
larynx, but also the Videofluoroscopic and Videoendoscopic
Swallowing Studies (VFSS and VESS, respectively).
Swallowing
disorders amenable to surgery
The primary disorder here is cricopharyngeus muscle
(upper esophageal sphincter) dysfunction (CPD), with or without
Zenker’s diverticulum (ZD). In many locales, this can
legitimately be considered an “orphan” disorder,
in that it is sufficiently uncommon that few physicians develop
significant experience and expertise with it. For that reason,
Bastian Voice Institute physicians attract patients with this
problem from a wide region.
While at Loyola University Medical Center,
Dr. Bastian introduced the endoscopic rather than open (through
a neck incision) method for dealing with CPD +/- ZD. Drs.
Bastian and Richardson believe that they currently have unrivaled
experience with this condition in the upper Midwest.
Under a short general anesthetic, the patient
undergoes esophagoscopy through the mouth after which the
carbon dioxide laser is used to divide the offending non-relaxing
muscle so that it will allow solid food in particular to pass
more easily. Some patients can undergo this restorative surgery
as an outpatient; others spend a single night in the hospital
and are discharged to home the morning following surgery.
Patients who undergo this procedure are
typically extremely pleased with the enhancement to their
quality of life: before surgery they may have been limited
to liquids, puree consistency foods, and maybe some soft foods.
Solid food and pills consistently lodged in the throat at
the level of the mid to low neck. After surgery, the ability
to eat a more normal diet is typically restored, or at the
least is markedly improved.
Videoendoscopic
Swallowing Study (VESS)
VESS is a comprehensive, often stand-alone methodology
patterned in many ways after the videofluoroscopic swallowing
study (VFSS). The latter uses three consistencies of food
material – liquid, puree, and solid – mixed with
barium and administered under the supervision of a speech
pathologist in the radiography suite of Good Samaritan Hospital.
By contrast, VESS uses visual videoendoscopic imaging of the
swallowing tract. The patient’s anatomy and neurological
examination (palate, pharynx, and larynx) are first assessed
in detail using various elicitation techniques. The presence
or absence of retained saliva is next noted. Finally, the
patient is offered, in an appropriate sequence, water, pudding,
and cracker each stained with food coloring to assess swallowing
ability. When there is question about esophageal function,
VFSS may also need to be done. When VFSS has already been
done, or when follow-up swallowing studies are needed, VESS
typically is used as an alternative to VFSS.
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