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[Dysphagia] Oral thrush
Just wanted to second these comments about thrush (candidaisis). You can
have it in the esophagus and/or upper airway without it being visible in
the mouth, and it is always worth thinking about if patient at risk
(recent antibiotics and/or low immune function) is having a lot of pain
with swallowing despite good acid blocking and you can't see any cause.
This needs not just topical nystatin but more potent systemic therapy for
a longer time, e.g. with oral fluconazole or miconazole for at least a
week,and occasionlly even IV if severe. We had a dramatic case in a
patient with high quadriplegia, he just could not eat and would throw up
and was in terrible pain until we figured it out.
See if your ENT or GI would take a quick look with a scope to confirm or
refute for you...
It is not always bright white like curdled milk but I have always been
taught the same thing - if it easily scrapes off, it is not thrush.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Wed, 19 Apr 2006, Deanna Rolfe wrote:
> Could oral thrush cause dysphonia (assuming that it is in the larynx
> too...hasn't been visualized)??
>
> I have a patient who has very bad oral thrush, who says its like
> swallowing razor blades, who has lost his voice also in the last couple
> of days (intermittent aphonia, but voicing is very breathy when
> achieved).
>
> He has lung cancer, so the thought also crossed my mind that there may
> be some other nasty involved in the voice loss, but wondered about the
> thrush first.
>
> Deanna
> Australia
>
>>>> "Pressman, Hilda" <pressmah@sjhmc.org> 19/04/2006 12:20:30 am >>>
> Thrush looks like curdled milk. It is related to immune suppression but can even occur in individuals who have only been on antibiotic. It can be quite painful. In the mouth I have seen it on the tongue, palate and gums. It can also be present in the esophagus and can cause painful swallowing. It is responsive to meds, however the esophageal thrush takes much longer to clear up than the oral thrush. Hilda Pressman MA, CCC SLP BRS-S
>
> -----Original Message-----
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
> Behalf Of TERRY W. BAGGS
> Sent: Wednesday, April 12, 2006 9:50 AM
> To: Paula leslie; Alexandra Mitchell; dysphagia
> Subject: RE: [Dysphagia] Oral thrush
>
>
> I find that most new folks (students, CFs, etc) tend to confuse simple
> oral gunk with thrush. A pretty good way to tell the difference is to
> try to remove it. Oral gunk will come off. Thrush will not. I always
> go to the nurse in charge of that patient. Oftentimes, they're so busy
> with other things, they have no clue about the thrush.
>
>
>
> -----Original Message-----
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
> Behalf Of Paula leslie
> Sent: Wednesday, April 12, 2006 1:29 AM
> To: Alexandra Mitchell; dysphagia
> Subject: RE: [Dysphagia] Oral thrush
>
> Hi Alexandra
>
> I'm not the best oral examiner in the world so I probably over estimate
> but
> these look like many of the mouths I see on the wards. I am obsessed
> about
> oral hygiene. If in doubt I always mention it to the nurse or HCA,
> often
> gently like "is this person receiving any treatment for an oral
> infection?"
> to find out if the med team already know. If they do that's great and
> then I
> go on about oral health and chest infections (ad nauseam... does get the
>
> message through), and how painful mouths affect eating and swallowing.
> So how
> great it is that they're treating it.
>
> If they aren't treating then I ask them to come and have a look and "oh
> is
> that thrush etc?" Then I go on about oral hygiene and chests..... you
> know.
> So - get it treated. If it's bad enough I'll say that they might want
> to
> consider non-oral supplementation because the pt is never going to
> manage
> adequate hydration and nutrition orally.
>
> But cases differ, most of mine are elderly care, H&N is different, Ca is
>
> different. If any hint of it then do mention it, it's up to the med
> team to
> decide what to do, but you can give them some info on oral hygiene,
> chests,
> hydration and nutrition etc that will help inform their decision.
>
> And some lovely pictures for (UK) breakfast time!
>
> Good Luck!
>
> Paula
>
>
>
> http://www.lib.uiowa.edu/hardin/md/dermnet/thrush.html
>
> http://images.google.com/imgres?imgurl=http://www.lib.uiowa.edu/hardin/m
> d/pictures22/cdc/PHIL_2925_lores.jpg&imgrefurl=http://www.lib.uiowa.edu/
> hardin/md/cdc/2925.html&h=476&w=700&sz=24&tbnid=ViT9RpqPxz_10M:&tbnh=93&
> tbnw=138&hl=en&start=5&prev=/images%3Fq%3D%2Boral%2Bcandida%26svnum%3D10
> %26hl%3Den%26lr%3D%26rls%3DRNWE,RNWE:2005-51,RNWE:en>===== Original
> Message From Alexandra Mitchell <pawprint1980@yahoo.com.au>
> =====
>> Hello everyone,
>>
>> I am fairly new to speech pathology and I was wondering if someone
> could
> inform me about:
>>
>> What oral thrush looks like and
>> When it is significant/severe enough to inform the medical team that
> they
> need to do something about the amount etc
>> Thanks so much for any information
>>
>> Alexandra
>
> Paula Leslie
> Degree Programme Director
> RCSLT Specialist Advisor in Dysphagia
>
> Surgical and Reproductive Sciences
> Faculty of Medical Sciences
> University of Newcastle
> Newcastle upon Tyne
> NE2 4HH
> UK
> +44 (0) 191 222 6279(T)/8988(F)
> http://www.ncl.ac.uk/sars/postgrad/MSc.htm
>
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