Modified Mondays: Zenkers Take Two



For today’s #ModifiedMonday, we share another example of a Zenker’s diverticulum and discuss what to do when SLPs are told they can’t instrumental.


This is a great share from one of our SLPs, Tobi, on our Columbus, Ohio team. This patient presented clinically with complaints of feeling “too tired” to eat after just a few bites, with occasional cough, and expectoration of food after swallowing. The facility SLP suspected pharyngeal residues, since the patient was also noted to have multiple swallows for each bite/sip. The patient had also coughed up pills in the past, several minutes after taking them. Even though the SLP had some clinical suspicions for pharyngeal residue/impaired pharyngeal contraction/base of tongue retraction, they decided an instrumental was warranted-thankfully! You can see the quite large diverticulum very clearly, as well as the retrograde flow of the bolus from the diverticulum back into the pharynx, which the patient subsequently aspirates (with an inconsistent cough response). See the link below for info on Zenker’s, if you missed our previous post! 


PS: I hear from many SLPs that tell me that their admin “won’t allow” instrumentals for dysphagia. This is a frequent topic in SLP groups on Facebook and SIG 13. The fact is, the longer we as a profession continue to accept this... the longer it will persist. If it is available at ALL in the area, patients should be getting it. Studies like this one are a great example to discuss with administration. Had this patient NOT received our services, not only would have the very necessary referral have been missed, a very inappropriate plan of care would have been implemented. I always encourage SLPs to share these “success stories” … and to remind admins that they will be documenting their recommendations for instrumental assessment. It’s not comfortable-but our obligation is to our patients first and foremost. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/

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