DeVita and Spierer-Rundback identified swallowing disorders in patients who have had prolonged orotracheal intubation or tracheostomy tube placement. Many of these patients will develop swallowing difficulties and/or dysphagia that usually improve over time. The authors are from the University of Pittsburgh and St. Vincent's Hospital in New York City.


Patient evaluation: barium swallow with videofluoroscopy at 30 frames per second


Potential problems in the swallowing sequence:

(1) lingual incoordination

(2) disorder of oral transfer

(3) problems with laryngeal elevation

(4) nasopharyngeal reflux

(5) disorder of tracheal penetration

(6) delayed triggering

(7) inconsistent triggering

(8) cricopharyngeal spasm

(9) problems with the gag reflex

(10) vallecular pooling

(11) piriform pooling


Grading for each problem:

(1) none (normal)

(2) mild

(3) moderate

(4) severe


Aspiration can occur even when the gag reflex is normal.


Patients with 1 or more moderate or severe problems should be monitored more closely and instructed in hour to reduce the risk of aspiration while swallowing.


To read more or access our algorithms and calculators, please log in or register.