day1 1115-1215 goudy-dysphagia-2014...case 1 • exam findings include: – hoarse voice – upper...
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Dysphagia Panel
Gwen Provo‐Bell and Steven Goudy Pediatric Otolaryngology
Vanderbilt University Medical Center
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Disclosure
• I have nothing to disclose
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Case 1
• 10 yo with history of neuroblastoma spresection and xrt 6 years ago
• Upper and lower motor weakness• Admitted to PICU for recurrent PNA with 6 in the last year
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Case 1
• Exam findings include:– Hoarse voice– Upper and lower motor weakness– Tongue fasiculations
• Next step?– Bedside swallow study– Videofluoro swallow study– Flexible endoscopic evaluation of swallowing
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Case 2
• 6 yo with history of cardiac transplant• Ongoing coughing with oral feeding• Hoarse and breathy voice• Intermittent pneumonia • No history of GERD
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Case 2
• Flexible bedside evaluation demonstrates immobile left TVC
• Next Steps?– Observation?– Injection medialization?
• Gelfoam• Cymetra• HA
– Nerve reinnervation?
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Case 3
• 5 yo with bilateral vocal cord paralysis• Sp endoscopic posterior graft• Post‐operatively has significant pain and dysphgia
• Next step?– Videoswallow– Beside swallow– FEES
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Case 4
• 10 month old with ongoing cough• Recurrent pneumonia • Always sounds “sick”• What to order?
– Bedside evaluation– FEES– VFSS
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