Newsletter :: September 2006

RSI – Reflux Symptom Index ( Murray, T, Carrau, R, 2006)

A Score greater than 10 strongly suggests laryngopharyngeal reflux

(0= no problem, 5= severe problems)

1. Hoarseness or voice problem 1 2 3 4 5

2. Clearing of throat 1 2 3 4 5

3. Excess Throat Mucous or postnasal drip 1 2 3 4 5

4. Difficulty swallowing food, liquid, pills 1 2 3 4 5

5. Coughing after you eat or lay down 1 2 3 4 5

6. Breathing difficulties or choking episodes 1 2 3 4 5

7. Troublesome or annoying cough 1 2 3 4 5

8. Globus sensation 1 2 3 4 5

9. Heartburn, chest, indigestion 1 2 3 4 5

Dysphagia Tidbit – Dysgeusia and Burning Mouth Sensation

Dysgeusia is a chronic taste sensation of unknown cause while Burning Mouth Sensation (BMS) is a chronic oral pain sensation in the absence of pathology. Some causes of dysgeusia reflect actual tastants that have gained access to the mouth such as: reflux, postnasal drip, halitosis, infection, medications in saliva or gingival fluid. Taste phantoms refer specifically to dysgeusias that originate within the nervous system (Bartoshul, Kveton, Yanagisawa, & Catalanotto, 1994)

Patients with taste phantoms or BMS usually show localized taste damage particularly on the anterior tongue. When taste is damaged, the inhibitions it produces is abolished, leading to abnormal activity in brain areas previously inhibited. Women are more likely to experience these phantoms. The loss of bitter perception at menopause appears to disinhibit oral pain and place a greater risk for BMS. The first step to assessing oral sensory dysfunction is to determine the origin of the sensory complaint.

GUSTATORY STIMULATION – Various liquids are placed on the individuals tongue with an eye dropper. This procedure is utilized to determine which gustatory stimuli result in an increase in sensory feedback. This information will determine whether certain tastes will inhibit or facilitate neuromuscular tone (Payne, Joyce). Suggested substances to be used are:

Salty Bitter Sweet

Salt water lemon juice syrup

Saltine crackers vinegar vanilla

Bullion pickle juice honey

Tomato juice grapefruit juice jelly

WEST NILE VIRUS – Symptoms include Dysphagia (Moshiem, J., 2006)

This disease is spread by female mosquitoes and peak months for the disease are July, August, and September. Elderly people and those with poor immune system are more susceptible to symptoms of West Nile. Curiously, the virus can mimic neurological diseases such as Parkinson’s Disease, Bell’s Palsy, and Guillian-Barre Syndrome. Madonna Rehab Hospital in Lincoln, Nebraska had 27 patients; ages 24-91 admitted with a diagnosis of West Nile and 20 had dysphagia. Symptoms included severe oral and pharyngeal weakness and difficulty moving the tongue and lips. Some demonstrated absent pharyngeal swallow and laryngeal elevation resulting in difficulty managing secretions and saliva. Seventeen patients were admitted NPO and eight remained NPO after D/C. Twelve of the 27 required a tracheotomy tube and 8 needed vent support. FYI – There has been an increase in cases in Northeast Tarrant County over last year.

Past Conference Booklet Sale

We have several copies made and we will sell at this price until gone

Call DiagnosTEX to order

DYSPHAGIA 101 – $5.00

Bedside Swallow Evaluation – $7.00

NPO – Ethics and Challenging case Management – $10.00