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Clinical Updates

 
Head and Neck Surgery

New Swallowing Disorders Clinic at UCLA offers sophisticated outpatient procedures

09/01/2006

UCLA’s new Swallowing Disorders Clinic provides expert personnel and state-of-the-art equipment for the diagnosis and treatment of swallowing disorders. Swallowing problems (dysphagia) can occur at any point in the process of moving food and liquid from the mouth through the throat (pharynx), into the esophagus and to the stomach. These problems may result in poor nutrition, dehydration or aspiration (accidental ingestion of food particles or fluids into the lungs). Swallowing disorders are often accompanied by voice impairment (dysphonia).

Symptoms

Indications of a swallowing disorder may include:

  • Frequent choking on food
  • Hesitancy in swallowing food
  • Coughing during or immediately after eating and drinking
  • Pain during swallowing
  • Recurring pneumonia
  • Unexplained weight loss
  • Heartburn

Causes

Patients may suffer from swallowing or voice difficulties for a number of reasons, including:

  • Stroke or other forms of acute neurological damage
  • Head and neck cancers
  • Radiation therapy to the neck
  • Heart or other chest surgery, which may lead to vocal cord weakening or paralysis
  • Trauma to the throat or larynx
  • Degenerative neurological disorders such as dementia, Alzheimer’s disease, multiple sclerosis or Parkinson’s disease, or Lou Gherig’s disease (amyotrophic lateral sclerosis)
  • Pharyngeal and esophageal sacs (diverticulum) and narrowing (stenosis)
  • Age-related changes
  • Tracheostomy tubes (tube surgically inserted into the trachea)

Diagnosis and treatment

The Swallowing Disorders Clinic offers an array of sophisticated diagnostic tools and treatment modalities. Many procedures that are performed at other centers using sedation in an operating room can be administered in the Clinic suite using topical anesthesia. Procedures include:

  • Fiberoptic endoscopic evaluation of swallowing: a fiberoptic scope inserted through the nose is used to observe the patient’s swallowing process
  • In-office endoscopy: this new procedure allows physicians to examine the entire swallowing apparatus -- from mouth to stomach -- without sedating the patient
  • Distal chip endoscopy: a video camera on the tip of the endoscope provides physicians with high resolution images of the swallowing process
  • Endoscopic injection: botox injections relieve swallowing difficulties by easing tightness in the upper esophageal sphincter
  • Vocal cord injection: voice and swallowing capabilities can be restored or enhanced through the injection of collagen and other materials
  • In-office laryngoscopy with biopsy: examination and biopsy of the larynx can be performed in the Clinic under topical anesthesia, rather than in an operating room under sedation
  • Wireless pH monitoring for gastroesophageal reflux: eliminating the need for a catheter, this technology involves a capsule which is inserted and attached to the wall of the esophagus. It transmits signals to a receiver, worn on the patient’s waist band, which measures the frequency, duration and degree of stomach acid reflux into the lower esophagus.

The Clinic’s unique approach involves evaluation of patients with swallowing problems by both an otolaryngologist and a speech pathologist. Usually, these specialists work in separate clinics, requiring the patient to seek care in multiple locations. After evaluating the patient, Clinic physicians develop a comprehensive surgical, medical or rehabilitation management plan, tailored to the individual patient.

Additional consultation is available from neurologists, gastroenterologists and surgeons especially interested in the care of patients with dysphagia.

Program physicians:

Dinesh K. Chhetri, M.D.
Director, Swallowing Disorders Center
Assistant Professor of Surgery

Andrew Erman, M.A., C.C.C.-S.L.P.
Speech Pathologist
Manager, Speech Pathology Clinic

Contact information:

(310) 794-4225 Information and Referral
(310) 206-6688 Appointments





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