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Therapeutic intervention in oropharyngeal dysphagia

Nature Reviews Gastroenterology & Hepatology volume 13, pages 665–679 (2016)Cite this article

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This article has been updated

Key Points

  • Strong supportive evidence of effectiveness is not available for many dysphagia treatments so clinicians need to use best available evidence to support therapy choice

  • Unlike compensatory strategies, behavioural exercise therapies offer the opportunity for long-term, and perhaps even permanent, improvements in the rehabilitation of the oropharyngeal swallow

  • The elements of feedback, education and patient compliance are critical in our design of exercise therapies, and made even more so with exercises that patients independently execute over time

  • Evidence-based practice is only meritorious if it actually benefits both the patients' swallow physiology and health

  • Therapy must be tailored to an individual recognizing the person's disease, limits, attitudes, support systems and comorbidities

Abstract

Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies — focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.

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Figure 1: Level of evidence pyramid for evidence-based medicine.
Figure 2: Barium contrast image of a cricopharyngeal bar.
Figure 3: Endoscopic view of Zenker diverticulum.
Figure 4

Change history

  • 27 September 2016

    In the version of this article orginally published online, there was an error in the title. The error has been corrected for the HTML and PDF versions of the article.

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Acknowledgements

R.M. is supported through a Canada Research Chair (Tier II) in Swallowing Disorders.

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  1. Rosemary Martino and Timothy McCulloch: Both authors contributed equally to this work.

Affiliations

  1. Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160–500 University Avenue, M5G 1V7, Ontario, Canada

    Rosemary Martino

  2. Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11–331), Toronto, M5T 2S8, Ontario, Canada

    Rosemary Martino

  3. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, 53792, Wisconsin, USA

    Timothy McCulloch

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Martino, R., McCulloch, T. Therapeutic intervention in oropharyngeal dysphagia. Nat Rev Gastroenterol Hepatol 13, 665–679 (2016). https://doi.org/10.1038/nrgastro.2016.127

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