Speech pathologist practice patterns for evaluation and management of suspected cricopharyngeal dysfunction

Abstract

Speech pathologists are often the first professionals to identify signs of a cricopharyngeal (CP) dysfunction and make recommendations for further care. There are many care options for patients with CP dysfunction, but it is unclear how certain interventions are used in practice. A paper-based survey employing two clinical cases involving suspected CP dysfunction (Case 1 with adequate pharyngeal strength and Case 2 with coexisting pharyngeal weakness) was sent to members of American Speech-Language Hearing Association's Special Interest Group 13. Respondents ranked the order of management approaches (swallowing therapy, further evaluation, and referral to another medical professional) and selected specific interventions under each approach that they would recommend for each case. Completed surveys from 206 respondents were entered into analysis. The majority of the respondents recommended swallowing therapy as a first approach for each case (Case 1: 64 %; Case 2: 88 %). The most prevalent swallowing exercises recommended were the Shaker (73 %), effortful swallow (62 %), and Mendelsohn maneuver (53 %) for Case 1 and effortful swallow (92 %), Shaker (84 %), and tongue-hold swallow (73 %) for Case 2. 76 % of respondents recommended a referral for Case 1, while 38 % recommended the same for Case 2. Respondents with access to more types of evaluative tools were more likely to recommend further evaluation, and those with access to only videofluoroscopy were less likely to recommend further evaluation. However, the high degree of variability in recommendations reflects the need for best practice guidelines for patients with signs of CP dysfunction.

Figure 1

Percentage of respondents who recommended swallowing therapy, further evaluation, and referral to a physician as a first, second, or third approach in each clinical case.

Figure 2

Specific therapeutic exercises recommended, by case. Percentages are taken from all who recommended therapy; 92.2% for Case 1 and 96.6% for Case 2.

Figure 3

Specific evaluative modalities recommended, by case. Percentages are taken from all who recommended evaluation; 24.8% for Case 1 and 25.7% for Case 2. FEES: Fiberoptic Endoscopic Evaluation of Swallowing; EMG: electromyography.