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The most investigated GABABR isoforms are GABAB1(a) and GABAB1(b), family history of cancer, hoarseness, odynophagia, otalgia, tobacco, smoking, alcohol abuse); history of neurologic, connective tissue, or autoimmune disorders; recent dietary changes AssociatedSymptoms:voicechanges(laryngealinvolvement),heartburn (reflux esophagitis), hypothyroidism (fatigue, hair loss, depression, weight gain), neurological changes (weakness, paresthesias, diplopia, vertigo, mental status changes) PhysicalExam:fullneurologicexam(cranialnervesandperipheral exam), indirect laryngeal exam or nasopharyngeal scope (pooling of secretion, vocal fold mobility, masses), complete head and neck exam with high suspicion for malignancy (palpation of base of tongue, indirect mirror exam for lesions, evaluate nasopharynx), thyroid palpation ThinkKITTENSfordifferentialdiagnosis(seeTable45) Modified Barium Swallow (MBS) MBS:radiographicvideofluoroscopicstudythatvisualizesoraland pharyngeal phases of swallowing typicallyreviewedwithaswallowingtherapist utilizesvaryingbolusamountsandconsistencies determinesoralandpharyngealmotility,laryngotrachealelevation, laryngeal penetration or aspiration, and safety of oral feeding Other Ancillary Tests Esophagram(BariumSwallow):evaluatesesophagealphaseof swallowing (motility), luminal integrity (large ulcers, intrinsicextrinsic masses, strictures, webs), reflux Manometry:measuresduration,amplitude,andvelocityofperistaltic waves ChestX-ray:revealspneumonitis,pneumonia,masses,oradisplaced airway LaryngoscopyandEsophagoscopy:indicatedifsuspectmalignancy, for uncertain etiology, to evaluate esophagus, to remove foreign bodies, and to biopsy a mass or lesion Functional(Fiberoptic)EndoscopicEvaluationofSwallowing(FEES): allows bedside evaluation of swallowing function, nasopharyngoscopy utilized to visualize swallowing phases, may assess for aspiration, penetration, and pharyngeal and laryngeal function DyedFood:indirectevaluationofaspirationinthepresenceofa tracheotomy, oral feeds are dyed (methylene blue), tracheotomy is suctioned to evaluate for the presence of stained aspirates GERDEvaluation:(seeGERDbelow) Videostroboscopy:evaluatesvocalfoldmotion,pooledsecretions,and anatomical defects (masses, glottal chinks, etc) Figure 12-6.
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