Reference no: EM133705128

Question

Dysphagia history: Before surgery, baseline diet was thin liquids, moist solids. He describes definite flavor/taste changes from his chemo, but he's "making it work." He complains of significant dry mouth for the whole 10 years: "I always keep a water bottle with me." He did not require a feeding tube during/after his H&N Ca treatment. He denies pneumonias before the AAA repair. He was recommended NPO in acute care after AAA repair, based on a clinical swallowing evaluation. After PEG was placed, no further PO intake in acute care, rehab, or at home. He has no previous MBSes that he can recall. He describes very limited swallow therapy, consisting of nonnutritive exercises only. He reports a recent ENT evaluation after discharge from rehab, and all he can tell you about it is that the ENT "couldn't pass scope low enough to evaluate for stricture." What exam would you perform first? A clinical evaluation, an instrumental evaluation (i.e., FEES or MBS), or defer to another provider for a different type of assessment?