[Dysphagia] Dysphagia in Dermatomyositis

[trlynch at doh.health.nsw.gov.au (Trudy Lynch)]

I am seeing a man with Dermatomyositis who has severe pharyngeal
dysphagia. He is very slowly responding to medical treatment in his
extremities but there has been no functional change in his swallow yet.
He is unable to manage any fluids or solids but has developed excellent
saliva management through expectoration - he now coughs up and spits out
secretions. 
My understanding of people with this condition, is that they get a very
wide pharynx and a tight upper oesophageal sphincter in addition to
their weak laryngeal movement. Unfortunately I have not been able to do
an MBS on this man but should be able to next week to determine what is
happening anatomically and physiologically.
He has become very anxious about swallowing so I have worked with him
alot to try to reduce that anxiety. He is also very motivated so I have
given him Masako and Shakers exercises so he can feel that he is working
to improve his swallow, although I have discussed with him the fact that
his swallow will only improve with the return of muscular function.
Does anyone know what the prognosis for recovery of swallowing is with
this disease? Any suggestions for management?
Many thanks for any input,
Trudy.

Trudy Lynch
Speech Pathologist
Royal North Shore Hospital
St Leonards NSW 2065
Phone: (02) 9926 7741
Fax: (02) 9926 6568

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