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Swallowing disorders in closed head trauma patients.

Fifty-three closed head trauma patients with dysphagia were examined videofluorographically to determine the specific nature of their swallowing disorder. Eighty-one percent of the patients exhibited a delayed or absent swallowing reflex while approximately 50% of the patients suffered from reduced tongue control, and 33% had reduced peristalsis. Laryngeal disorders and cricopharyngeal dysfunction occurred in a small number of patients. The average head trauma patient exhibited more than one swallowing motility problem. Twenty patients aspirated, with delayed or absent swallowing reflex as the most common etiology for the aspiration. Many of these patients did not produce a reflexive cough during or after they had aspirated material into their airway. For this reason, and since the pharyngeal stage of the swallow is extremely difficult to assess with presently available bedside techniques, videofluorographic evaluation becomes an invaluable tool for identification of the precise nature of the swallowing disturbance, the presence of aspiration, and the etiology of the aspiration.