Although swallowing difficulty (dysphagia) is not recognized as a primary symptom of the late effects of polio, many cases have been reported in the literature (Coelho & Ferranti, 1988, 1991; Ivanyi et al., 1994; Sonies & Dalakas, 1991). Incidence of dysphagia in polio survivors has been estimated to be approximately 18% (Coelho & Ferranti, 1991; Cosgrove et al., 1987) and is most prevalent in those individuals who had bulbar polio (Buchholz, 1994). Many of these individuals may not have had swallowing problems during their initial bout of polio.
The dysphagia may include the following problems: unilateral or bilateral pharyngeal wall weakness, reduced ability to retract the base of the tongue, and reduced laryngeal elevation resulting in decreased airway protection. These problems result in residues of food remaining in various areas of the pharynx, leaving the individual at risk for aspiration after the swallow (Logemann, 1998). Evidence also suggests that although impaired breathing may complicate swallowing dysfunction and vice versa, it does not appear that one can be predicted from the other. However, individuals with dysphagia and a reduced capacity to generate a productive cough appear to be at greatest risk for breathing difficulties (Coelho & Ferranti, 1991). As polio survivors age, they may also develop problems swallowing due to esophageal issues (not related to their prior polio)
With regard to general guidelines for management of dysphagia, any individual suspected of having swallowing problems should be referred for a modified barium swallow study (MBSS) or fiberoptic endoscopic swallowing evaluation (FEES), which is critical for defining the physiology of the swallowing dysfunction. The MBSS or FEES study should, whenever possible, include presentation of a variety of consistencies, e.g., thin and thick liquids, purées, soft solids, solids, etc., and quantities of contrast material consistent with the polio survivor’s everyday diet. The swallowing study also is key to identifying the most suitable noninvasive compensatory techniques to facilitate swallowing function. Swallowing function can be significantly improved by modifying positioning during swallowing, such as turning the head to one side or tilting the chin downward, or by modifying eating habits, such as avoiding certain consistencies or “problem foods,” alternating liquid and solid swallows, and swallowing twice for each bolus of food. Polio survivors with swallowing problems should avoid eating when extremely fatigued. Even minor swallowing problems appear to be aggravated by fatigue. In most cases, aggressive exercise will fatigue the mechanism more than strengthen it.
Polio survivors with dysphagia should have their swallowing assessed at regular intervals to monitor progressive changes as well as to determine whether compensatory techniques continue to be effective.
References
Buchholz, D.W. (1994). Postpolio dysphagia. Dysphagia, 9, 99-100.
Coelho, C.A., & Ferranti, R. (1988). Dysphagia in postpolio sequelae: Report of three cases. Archives of Physical Medicine & Rehabilitation, 69, 634-636.
Coelho, C.A., & Ferranti, R. (1991). Incidence and nature of dysphagia in polio survivors. Archives of Physical Medicine & Rehabilitation, 72, 1071-1075.
Cosgrove, S.L., Alexander, M.A., Kitts, E.L., Swan, B.E., Klein, M.V., & Bauer, RE. (1987). Late effects of poliomyelitis. Archives of Physical Medicine & Rehabilitation, 68, 4-7.
Ivanyi, B., Phoa, S.S.K.S., & de Visser, M. (1994). Dysphagia in postpolio patients: A videofluorographic follow-up study. Dysphagia, 9, 96-98.
Logemann, J.A. (1998). Evaluation and treatment of swallowing disorders. Austin, TX: Pro-Ed.
Sonies, B.C., & Dalakas, M.C. (1991). Dysphagia in patients with postpolio syndrome. New England Journal of Medicine, 324, 1162-1167.