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[DYSPHAGIA] Re DASBBS alternative treatments
Someone asked "Have you worked with a SLP?" ;-)
S has worked extensively with SLP / SLT at a University Hospital since
December 1998 operation and tried all the exercises suggested.
She has been referred to another "leading" ENT dept for a second opinion on
swallowing.
The second opinion has been given - could not help with the lack of movement
of the vocal cord, but did offer to inject Teflon into the immobile cord to
help voice production etc.
No alternative of medialisation thyroplasty was available or suggested, so
hence my earlier questions to the list.
I understand that the medialisation would help protect airway and "might"
help with swallowing by enabling more air pressure to be pushed against the
cricopharangeus muscle at the back of the throat?
I also understand that any modification to vocal cords can affect air flow
to lungs.
S's case is not typical dysphagia but DASBBS, and we are being optimistic to
think that medialisation could improve her swallowing or a spontaneous
recovery may still happen. In our position you've still got to try to be
optimistic.
The original SLT at University Hospital referred S to a Psychiatric
Consultant also.
No stroboscopic examination has been carried out on S's vocal cords.
Maybe the problem is too big for that to help?
The latest FEES reported the following -
- cranial nerve IX damaged - soft palate moves to right when mouth opens -
sensation and motor loss
- cranial nerve XII damaged - left hand side of tongue atrophied
- endoscope contact with left hand side of larynx resulted in no reaction -
meaning left hand side of vagus nerve X is "down", causing paralysis to left
hand side vocal cord.
- dysphagia likely to continue due to extent and combination of swallowing
cranial nerves affected by original skull base meningioma surgery.
The surgeon thought that with cranial nerves IX, X & XII being affected,
chronic dysphagia would be likely to continue, but would not rule out the
possibility of a spontaneous recovery in the future.
Neurological damage prevents S from being able to swallow saliva at the
moment. Her operation was in December 1998, trachy tube taken out in June
1999, so it has been 2.25 years since, with no indications of neurological
recovery.
The 2nd opinion surgeon suggested doing a Teflon injection to S's immobile
vocal cord to help breathy voice and breathing control. This operation is
irreversible. S is obviously keen to improve but we are aware that the
Teflon operation carries risks and might inhibit future spontaneous
recovery?
Recently discovered web site for medical discussion of treatment
alternatives -
http://www2.utmb.edu/otoref/Grnds/VC-paralysis-001108/VC-paralysis-001108.ht
m
As the Teflon injection surgery is not reversible, we are looking for
alternatives.
We need more advice on success rates of available alternatives .
We want to try Marcy Freed's electrical stimulation in Cleveland, Ohio prior
to further surgery.
We also would value your opinions and feedback.
Best wishes
Vaughan Morris
Nottingham, England
vandsmorris@ntlworld.com
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