Therapeutic intervention in oropharyngeal dysphagia.
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.|Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada.
Rosemary
R
Martino
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA.
Timothy
T
McCulloch
D001521:Behavior Therapy; D001905:Botulinum Toxins / Q000008:administration & dosage; D002986:Clinical Trials as Topic / Q000379:methods; D003680:Deglutition Disorders / Q000628:therapy*; D004106:Dilatation / Q000379:methods; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D015552:Injections, Intralesional; D009498:Neurotoxins / Q000008:administration & dosage; D010614:Pharynx / Q000601:surgery; D011015:Pneumonia, Aspiration / Q000517:prevention & control / Q000601:surgery; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000601:surgery; D016672:Zenker Diverticulum / Q000175:diagnosis / Q000601:surgery
D009498:Neurotoxins; D001905:Botulinum Toxins