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.