The patient is a 46-year-old male presenting with perfuse sinus damage and occasional food material coming out of the nose when blowing it. The patient reports occasionally coughing on saliva or liquids. First it is essential to conduct a patient interview in order to gather pertinent information regarding medical history, patient motivation and family support. Next, a swallowing evaluation should be performed.
It is recommended that a certified clinician or physician perform a Fiberoptic Endoscopic Evaluation Study (FEES) in order to assess velopharyngeal insufficiency. The International Working Group (IWG) Guidelines for standardizing reporting of information about velopharyngeal functioning are based on ratings and measurements that will…show more content… A bifid uvula may indicate that the patient has an undiagnosed submucosal cleft palate, which could be the cause of the velopharyngeal insufficiency. The hypoglossal cranial nerve (XII) should be analyzed by prompting the patient to protrude the tongue and move it laterally from side to side to assess lingual strength, movement and coordination. If lack of base-of-tongue movement persists during the oral transit phase of the swallow, then a driving pressure force will not be sustained in order to elicit pharyngeal constriction. tential explanation of coughing on saliva and liquids.
References
Antonios, N., Carnaby-Mann, G., Crary, M., Miller, L., Hubbard, H., Hood, K., Sambandam, R., Xavier, A., Silliman, S. (2010). Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit: The modified mann assessment of swallowing ability. Journal of Stroke and Cerebrovascular Diseases, 19(1). 49-57.
Carnaby, G. (2012). Food for thought: Importance of a clinical exam/cranial nerve assessment. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 21(4), 143-149.
Carnaby-Mann, G., & Lenius, K. (2008). The bedside examination in dysphagia. Physical medicine and rehabilitation clinics of North America, 19(4),
