Swallowing Disorders Center

Otolaryngologist Scott Gibbs, MD

The Swallowing Disorders Center is staffed by five certified and licensed speech language pathologists who perform the most recent diagnostic and therapeutic services on patients from infancy through adulthood. Under the direction of otolaryngologist Scott Gibbs, MD, the center evaluates and treats patients with oropharyngeal dysphagia, which is defined as difficulty swallowing because of a problem in the mouth or throat. Swallowing problems can occur as a result of nervous system disorders, certain cancers or cancer treatments, cleft lip or cleft palate or from a neurological impairment related to stroke, dementia, multiple sclerosis, Parkinson's Disease or a closed head injury.

Diagnostic Evaluations

Diagnostic evaluations may be performed on patients from infants to the seniors:

• The barium swallow (MBS) is performed in Radiology by the speech language pathologist and a radiologist.
• A dysphagia diagnostic exam called FEES (fiber-optic endoscopic evaluation of the swallow) is performed in the center by a speech-language pathologist as directed by Dr. Gibbs. A small, flexible scope is placed into the nose and positioned at the back of the throat to watch the swallow from above.

The speech pathologist looks at the function of the structures of the swallow while the physician looks at the physical component to determine any abnormalities. Some patients undergo both a barium swallow and FEES, while some patients have one or the other. The tests offer very different methods of evaluating the swallow.

Treatments

Once the patient's swallow has been evaluated and treatment is recommended, he or she may return to the hospital for dysphagia treatment, which is called Neuromuscular Electrical Stimulation (NMES). Using the FDA-approved VitalStim System to provide NMES, electrical stimulation is applied to the throat and facial muscles while the patient is actually eating or drinking. Treatment sessions last an hour and take place several days a week. After 12 to 15 sessions, the patient's swallow is reassessed for progress.

Deep Pharyngeal Neuromuscular Stimulation (DPNS) is another treatment used to treat dysphagia. It involves swiping frozen swabs along the muscles of the mouth and throat to stimulate a swallow, gag or salivation. This treatment is optimal if there is a sensory deprivation of the mouth and throat that is contributing to the dysphagia. The treatment lasts for about 45 minutes several days a week, with a reassessment after about a dozen sessions.

Traditional dysphagia therapy involves exercising the mouth and throat structure and requires maximum effort from the patient in order for the treatment to be successful. Usually, traditional exercises are incorporated with the VitalStim and DONS methods. The FEES equipment initially used for evaluation is also an excellent source for providing visual feedback to a patient during treatment, because the patient can use the monitor to watch himself or herself swallow and exercise the structures.

The center is open Monday through Friday from 8 a.m. to 4:30 p.m. Patients are seen after being referred by a physician. For more information or questions about the center, call 304.526.6335 or 304.526.2077.

Illustration courtesy of the National Institute on Deafness and Other Communication Disorders (NIDCD)