Multidisciplinary evaluation and management of dysphagia: the role for otolaryngologists.

ABSTRACT

INTRODUCTION: The Dysphagia Clinic of the McGill University Health Centre (MUHC) is composed of a multidisciplinary team including an otolaryngologist, a speech therapist, an occupational therapist, and a nutritionist. The clinic was created to provide a comprehensive assessment of patients with dysphagia. All patients are evaluated with flexible endoscopic evaluation of swallowing (FEES) and other necessary investigations. Following this evaluation, appropriate treatment, dietary modifications, and swallowing techniques are taught to the patient. OBJECTIVE: To study the characteristics of the population evaluated at the McGill University Health Centre Dysphagia Clinic to better understand the role and impact of a multidisciplinary team. METHOD: A retrospective chart review of 183 patients presenting to the Dysphagia Clinic since its creation in December 2004 was conducted. Information regarding demographics, etiology, comorbidities, additional referrals or investigations, treatment, and outcome was collected. RESULTS: The majority of patients (61%) were referred by otolaryngologists. The FEES was normal for all consistencies in 28% of patients, and pooling was the most frequently encountered abnormality. The most common etiologies were neurologic (27%), laryngopharyngeal reflux (22%), and malignancy (21%). The four treatment modalities consisted of dietary modifications (37%), teaching of therapeutic swallowing manoeuvres (33%), medical treatment (26%), and surgical treatment (11%). CONCLUSION: A multidisciplinary dysphagia clinic is an invaluable resource for patients suffering from cervical dysphagia. As the etiologies and initial presentation of patients vary greatly, otolaryngologists' expertise in endoscopy gives them a critical role in the evaluation of this condition.