Context: Reductions in the length of acute care hospitalizations have resulted in earlier transfer of patients with significant neurologic disease, such as head injury or stroke, to inpatient rehabilitation facilities. In many instances, these patients arrive at the rehabilitation hospital with multiple unresolved acute processes, including undetected or inadequately evaluated dysphagia. These patients may be at significant risk for the development of aspiration pneumonia, especially if elderly or debilitated.
Objective: To review the role of otolaryngologic consultation in the management of inpatients in two rehabilitation hospitals.
Design and setting: Retrospective review of 1046 consultations performed by two otolaryngologists over a 4-year period at two long-term inpatient rehabilitation hospitals in the Pittsburgh, PA, metropolitan area.
Results: A total of 833 patients were evaluated. Three hundred were seen for a variety of common disease processes, including hearing loss, and cerumen removal. A total of 548 consultations were for recommendations regarding swallowing dysfunction. Fibre-optic endoscopic examination of swallowing function was performed in 478 patients. Two hundred consultations were for assistance in decannulation of patients who were transferred from the acute care hospital with an indwelling tracheostomy tube.
Conclusions: The detection and evaluation of the aspiration risk of dysphagic patients in rehabilitation hospitals are enhanced by an onsite dysphagia team with access to instrumented measures of swallowing, especially videofluoroscopy or videoendoscopy. Otolaryngologic consultation can provide considerable benefit for many inpatients in rehabilitation hospitals, even those with apparent "minor" dysfunction. The otolaryngologist-head and neck surgeon is uniquely qualified to provide consultation in the management of those inpatients with complex clinical problems involving the upper aerodigestive tract. Consultation may be critical for some patients, assessing the cause and severity of dysphagia and assisting in the safe decannulation of those with indwelling tracheostomy tubes.