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Speech-language pathology: The pulmonology connection

Speech-language pathologists work closely with their physician colleagues to understand the influence of the many possible medical co-morbidities in pulmonology. This is notably the case in dysphagia.1 Tracheostomy and ventilator patients present a particular challenge in this regard. The interaction of pulmonary physiology and deglutition is problematic, particularly in the weaning process. For critically ill patients with acute respiratory failure as well, timely initiation of physical, occupational, and speech therapy is crucial to reduce morbidity and improve outcomes.

In Vocal cord dysfunction, whose etiology can be any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux or psychological conditions, speech therapy is one of the cornerstones of management.2,3 This is true as well in structural syndromes like laryngomalacia or glossoptosis,in which ​​dysphagia is prevalent, that can sometimes respond to speech and language therapy interventions.4 Myofunctional therapy is also a reasonable therapeutic option in obstructive sleep apnea-hypopnea syndrome (OSAHS). This therapy is regular exercising of the upper airway muscles to increase their tone and prevent their collapse.5

Multidisciplinary programs, that include oromyofunctional therapy, have emerged for coordinated and comprehensive care for the growing population of children with aerodigestive disorders, including complex airway, pulmonary, gastrointestinal, and feeding problems common in infants discharged from neonatal intensive care.6 Team care involving speech pathology even extends to chronic cough,7 whose etiology may sometimes involve an ineffective swallow, or esophageal reflux.8

1 Dikeman, Karen J., et al., The Interaction of Pulmonary Physiology and Swallowing: A Juggling Act for the Physician and Speech-Language Pathologist Perspectives on Swallowing and Swallowing Disorders (Dysphagia) March 2009 18(1):34-40. doi:10.1044/sasd18.1.34.

2 Kenn K, Balkissoon R. Vocal cord dysfunction: what do we know? Eur Respir J. 2011 Jan;37(1):194-200. doi: 10.1183/09031936.00192809.

3 Ibrahim WH, Gheriani HA, Almohamed AA, Raza T. Paradoxical vocal cord motion disorder: past, present and future. Postgrad Med J. 2007 Mar;83(977):164-72. doi: 10.1136/pgmj.2006.052522.

4 Gasparin M, Schweiger C, Manica D, Maciel AC, Kuhl G, Levy DS, Marostica PJ. Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis. Pediatr Pulmonol. 2017 Jan;52(1):41-47. doi: 10.1002/ppul.23484.

5 Borrmann PF, O'Connor-Reina C, Ignacio JM, Rodriguez Ruiz E, Rodriguez Alcala L, Dzembrovsky F, Baptista P, Garcia Iriarte MT, Casado Alba C, Plaza G. Muscular Assessment in Patients With Severe Obstructive Sleep Apnea Syndrome: Protocol for a Case-Control Study. JMIR Res Protoc. 2021 Aug 6;10(8):e30500. doi: 10.2196/30500.

6 Kaspy KR, Burg G, Garrison AP, Miller CK, Pentiuk S, Smith MM, Benscoter D. The follow up of complex infants in an aerodigestive clinic. Paediatr Respir Rev. 2022 Dec;44:3-10. doi: 10.1016/j.prrv.2022.06.002.

7 Spanevello A, Beghé B, Visca D, Fabbri LM, Papi A. Chronic cough in adults. Eur J Intern Med. 2020 Aug;78:8-16. doi: 10.1016/j.ejim.2020.03.018.

8 Irwin RS. Unexplained cough in the adult. Otolaryngol Clin North Am. 2010 Feb;43(1):167-80, xi-xii. doi: 10.1016/j.otc.2009.11.009.

MyoNews from BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.

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