Dysphagia Management with FEES

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Dysphagia Management with FEES

• Joy Hesse, M.A. CCC-SLP
• ENT Clinic of Iowa, P.C.
• 1455 29th St.
• West Des Moines, IA 50237
• [phone]
• entclinicofiowa.com
• AKA No one from no where!

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Zenkers Diverticulum

• Etiology of Zenkers diverticuli is unknown
• Reflux of material from the proximal esophagus
  back into the pharynx after the swallow

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Definition

• A diverticulum is a pouch or sac that is created
  by herniation of a muscle wall. Zenkers
  diverticula are pouches that develop in the
  pharynx just above the upper esophageal
  sphincter.

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Symptoms

• Dysphagia
• Regurgitation
• Cough after eating
• Aspiration pneumonia
• Weight loss
• Choking
• Regurgitation of undigested material
• Halitosis

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Case 2

• 74 y/o male
• Initially seen 8-13-07 c/o sore throat for six
  weeks. Weight loss of 15 lbs. over the past 3
  weeks, quit smoking 40 years ago. Also mild
  dysphagia,globus hot potato voice.

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Left Base of Tongue Mass
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Diagnosis

• T4NOMO
• Sqaumous cell carcinoma
• Underwent chemo/radiation therapy
• PEG placement at time of treatments

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Treatment

• Following radiation therapy patient diagnosed
  with upper esophageal radiation stricture,
  underwent endoscopic dilation and is presently
  performing daily dilations.

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Dysphagia Therapy

• Will need to continue self dilations.
• PEG removed and patient is taking soft solids,
  major complaint is prolonged meal times.
• Head tilt to right and side lying on right have
  been effective in reducing length of time for
  meals.

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References

• UTH Gastroenterology Grand Rounds - Discussion
• Zenker's Diverticulum Picturesby Christopher
  Chang, MD Last Modified 7/9/2007
• New England Journal of Medicine
• Hannan and Alusi 354 (23) e24, Figure 1     June
  8, 2006