[The management of dysphagia -- part 2: therapy].
In the first part of the article we described diagnostic methods aiming to resolve the individual underlying pathomechanism of chronic swallowing disorders (dysphagia). From these, we deducted different therapeutic measures that can be applied either alone or in combination. Weakening of the upper esophageal sphincter with botulinum toxin is reserved for patients with structural stenosis or a relative hyperfunction of the sphincter. It can be tried to use the "Passy-Muir Valve" for tracheostomized patients that aspirate. Most cases benefit from a therapy that consists of specific exercises. "Restitution" relies on exercises to practice new movement patterns as well as improvement of muscle strength. "Compensation" is based on exercises to counteract structural and/or functional deficits. Through "adaptation" residual, therapy resistant disease can be alleviated through dietary planning of consistency, temperature, and nutrient content of food. In many cases it is necessary to combine "restitution", "compensation", and "adaptation".
Schönweiler
R
R
Abteilung für Phoniatrie und Pädaudiologie (in der HNO-Klinik), Universitätsklinikum Schleswig-Holstein, Campus Lübeck. rainer.schoenweiler@phoniatrie.uni-luebeck.de
Raap
M
M
D001905:Botulinum Toxins / Q000008:administration & dosage; D002908:Chronic Disease; D003680:Deglutition Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D004940:Esophageal Stenosis / Q000503:physiopathology; D005081:Exercise Therapy; D006801:Humans; D007831:Larynx, Artificial; D011015:Pneumonia, Aspiration; D013060:Speech; D014140:Tracheotomy
D001905:Botulinum Toxins