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Modified Mondays: The Big Picture

SLPs can easily forget that swallowing is three dimensional when we watch it in two dimensions all the time. It is also hard to realize that swallowing is just one aspect of the patient’s medical status. This clip is great example of how thinking of the big picture, in more ways than one, resulted in a great catch and an appropriate referral by our MBS Envision SLP.

What you’ll want to pay close attention to here is the tiny chunk of barium that seems to fall into the airway vestibule just a few seconds in. It seems to pop back out of the vestibule, falls back in….looks like penetration, right? However, our SLP felt that the visual didn’t quite match with the physiology and wondered if something else could be happening. The patient was also having difficulty tolerating a speaking valve and hadn’t been successful with weaning from the trach at all.

We then suspected that the patient may have some laryngeal granulomas and recommended an ENT consult. Sure enough, a granuloma, or scar tissue, had developed and created a sort of “pocket” in the lateral pharyngeal wall-this is what the little chunk was popping in and out of. The patient also had additional granulomas that were obstructing the airway, thus the difficulty with weaning and valve use. Development of granulomas is the most frequent late effect complication in patients with tracheostomies, they sometimes require intervention, and always warrant a referral. Check out these link for more information: 

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