P&S Journal: Winter 1995, Vol.15, No.1
New Device Assesses Swallowing Problems
By Robin Eisner
The ability to swallow often becomes impaired as people age. Also, stroke victims have difficulty swallowing and can become malnourished or develop an often fatal condition called aspiration pneumonia when solid or liquid food repeatedly enters the lung and causes infection. Aspiration pneumonia kills approximately 50,000 Americans annually, most of them elderly.
Each year Columbia-Presbyterian Medical Center treats about 1,000 patients with stroke, 40 percent with difficulty ingesting food and fluids. Dr. Jonathan Aviv, an ear, nose, and throat specialist, sees many of these patients to determine the extent of their disability to prevent the malnutrition and pneumonia that often develop without medical intervention.
To better diagnose swallowing problems, Dr. Aviv, an Irving Assistant Professor of Otolaryngology, and Dr. John Martin, assistant professor of neurobiology and behavior, have invented a new way to measure the level of disability in stroke patients. The patent-pending technology detects the level of sensation loss in the throat. The device also can detect sensory deficits in people who undergo surgery for head and neck cancer. Research about the device was published in the Annals of Otology, Rhinology and Laryngology in October 1993.
For some time, explains Dr. Aviv, physicians have known that nerve damage in stroke patients causes motor or muscular deficits in the throat leading to swallowing problems, but motor deficits reflect only half the clinical picture in any individual. Physicians have hypothesized that these patients must have sensation problems associated with the swallowing problems, but they could not be detected.
"As people age, they lose feeling in the throat, which may explain why there is increased incidence of pneumonia in the elderly," says Dr. Aviv. "Knowledge of sensory discrimination in this area could ultimately reduce hospitalization and morbidity among the elderly."
The device consists of a fiberoptic endoscopic tube connected to an air puff generator and a video hookup. The tube is placed through the nose and down into the patient's throat to generate puffs of air of varying duration and intensity. Patients respond to the feeling of the puff. A video monitor allows the physician to put the air puff in the proper place. The outpatient procedure takes only 10 minutes.
When Dr. Aviv discovers a patient cannot feel the air puff, he recommends an intervention to prevent either pneumonia or malnutrition. Treatment could include diet modifications, such as substituting carbonated beverages for room temperature liquids and the addition of textured foods, which are more easily discernible to someone with impaired sensation. In more severe cases, patients could be fed through a nasal or gastric tube instead of by mouth. In some cases, microsurgical techniques could correct the sensory deficit.
Besides being a diagnostic tool, the device could monitor patient sensory recovery in stroke and cancer patients. Physicians could remove nasal and gastric tubes and return patients to liquid diets if the device detects the restoration of sensation.
Dr. Aviv has used a prototype to conduct approximately 2,000 tests in more than 100 patients. Columbia has licensed the device for a manufacturer to develop a product for neurologists, pulmonary specialists, gastroenterologists, otolaryngologists, and rehabilitation medicine specialists. The test is reimbursable by private insurance and Medicare.
Dr. Aviv is now studying use of the device in stroke patients who do not complain of swallowing problems but may have sensory deficits that could benefit from intervention.