Long-term dysphagia following thermal burn injury: An unusual longitudinal case study

Emma Vo1,2, Rochelle Kurmis2, Stuart Harper2, John Greenwood2

  1. Department of Speech Pathology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Australia
  2. Adult Burns Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Australia

Background

Dysphagia is a recognised negative outcome following burn-injury. Instrumental evaluation, including Fibreoptic Endoscopic Evaluation of Swallowing (FEES) and Modified Barium Swallow (MBS), combined with a clinical bedside swallowing assessment is recommended to accurately evaluate the complex and multifactorial nature of dysphagia post burn-injury. The literature surrounding post-burn dysphagia is largely limited to acute dysphagia, with minimal reports on long-term swallowing outcomes.

Method

Using MBS and FEES studies from 2007 and 2017, we compare and describe long-term swallow function, changes, and dysphagia management in a 64 year old female who sustained 32% TBSA burn injury in 2004 with associated inhalation injury requiring prolonged intubation and tracheostomy insertion. Swallow studies over time are evaluated and compared.

Results

Although aspiration and penetration reduced and pharyngeal and laryngeal sensation improved over time, swallow function became more effortful with reduced base of tongue to posterior pharyngeal wall movement, reduced hyolaryngeal excursion, piecemeal bolus transit through cricopharyngeus, and multiple swallows required to clear bolus. Over-time, the patient developed an unusual compensatory behaviour.  Longitudinal swallow investigations and multi-disciplinary management will be presented to highlight this atypical presentation.

Conclusion

This case highlights the importance of instrumental assessment such as MBS and/or FEES to further assess and track long-term dysphagia following burn injury to guide management decisions. It also emphasises the need for ongoing multi-disciplinary assessment and management of severe burn-injury patients following discharge. Larger longitudinal studies are needed to investigate swallow function in patients with dysphagia following burn injury.

Key Words

Dysphagia, burns, thermal injury, FEES, MBS.

 

References

  1. Rumbach, A. F., Ward, E. C., Cornwell, P. L., Bassett, L. V., & Muller, M. 2012. Clinical progression and outcome of dysphagia following thermal burn injury: a prospective cohort study. J Burn Care Res, 33, 336-46
  2. Rumbach, A. F., Ward, E. C., Cornwell, P. L., Bassett, L. V., & Muller, M. 2012. Physiological characteristics of dysphagia following thermal burn injury. Dysphagia, 27(3), 370-83
  3. Edelman, D. A., Sheehy-Deardorff, D. A., & White, M. T. 2008. Bedside assessment of swallowing is predictive of an abnormal barium swallow examination. J Burn Care Res, 29(1), 89-96
  4. Dubose, C. M., Groher, M. G., Mann, G. C. & Mozingo, D. W. 2005. Pattern of dysphagia recovery after thermal burn injury. J Burn Care Rehabil, 26, 233-7
  5. Clayton, N. A., Ward, E. C. & Maitz, P. K. 2017. Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review. Burns, 43, e7-e17

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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