Peter Belafsky, MD PhD The Otolaryngologist as • Professor and Director of the Voice and Swallowing Center, University of California-Davis Deglutologist • Vice Chair of Academic Affairs for the OTO-HNS Department • Internationally recognized as one of the Top Deglutologists in the Peter C. Belafsky, MD, PhD world [email protected] • Innovative approach resulting in numerous patents, “first in human” surgeries • Cross appointment with Veterinary School of Medicine • Lifetime Philadelphia Eagles fan – attended the Super Bowl and watched his team vanquish the Patriots
Confused Patient Three Bobs
Bob #1 Bob #2 Bob #3
Bob #1
H • 76yo solid & pill dysphagia • EAT10 - 25 EE • PILL5 - 13 • Community ENT (-) FEES • SLP (-) MBS Bob #2
• 72yo solid food dysphagia • EAT10 - 27 • PILL5 - 3 TIC • GI couldn’t pass EGD scope HH • GI couldn't pass Mano catheter
Bob #3
• 36yo solid food dysphagia • EAT10 - 27 • RSI - 19 • GI EGD - Esophagitis • Placed on Prilosec 20mg SMART PILL
Temperature 48hr
pH
Pressure
Time
Deglutology Palatal Valve
Oral Cavity Pharynx Labial Valve UES Esophagus
LES
Pylorus
Stomach
Labial Valve Oral Cavity
State-of-The-Art Diagnosis
State-of-The-Art Labial Valve Oral Cavity Labial Valve Oral Cavity
State-of-The-Art Treatment State-of-The-Art Treatment
Oral Care Exercise/Rehabilitation Rx Drying Agents Botulinum Toxin Saliva System
Labial Valve Oral Cavity Labial Valve Oral Cavity
State-of-The-Art Treatment State-of-The-Art Treatment
Frenulectomy Regenerative Medicine
Injectables Facial Reanimation Palatal Valve Palatal Valve
Oral Cavity
Pharynx State-of-The-Art Diagnosis Labial Valve UES Esophagus
LES
Pylorus
Stomach Palatal Valve Palatal Valve
State-of-The-Art Diagnosis State-of-The-Art Diagnosis
SSSSS K K K K
UES
Palatal Valve Palatal Valve
State-of-The-Art Diagnosis State-of-The-Art Treatment
SSSSS K K K K
Palate Obturator Injection Pharyngoplasty Pharyngeal Flap Palatal Valve Palatal Valve
State-of-The-Art Treatment State-of-The-Art Treatment
Palatal Valve Pharynx
Oral Cavity
Pharynx State-of-The-Art Diagnosis Labial Valve UES Esophagus
LES
Pylorus
Stomach Pharynx Pharynx
State-of-The-Art Diagnosis State-of-The-Art Treatment
Exercise Diverticulum Surgery Pharyngeal Reduction
Pharynx Pharynx
State-of-The-Art Treatment State-of-The-Art Treatment
Epiglottis Surgery Positive Pressure Negative Pressure Pharynx Pharynx
State-of-The-Art Treatment State-of-The-Art Treatment Palatal Valve UES
Oral Cavity State-of-The-Art Diagnosis Pharynx Labial Valve UES Esophagus
LES
Pylorus
Stomach UES UES
State-of-The-Art Diagnosis State-of-The-Art Diagnosis
UES UES
State-of-The-Art Diagnosis State-of-The-Art Treatment
Exercise Biofeesback UES UES
State-of-The-Art Treatment State-of-The-Art Treatment
CPM
Botulinum Toxin Dilation Myotomy Myotomy
UES
State-of-The-Art Treatment
Suspension SED
Palatal Valve Esophagus
Oral Cavity Pharynx Labial Valve UES Esophagus
LES
Pylorus
Stomach Esophagus Esophagus
State-of-The-Art Diagnosis State-of-The-Art Diagnosis
Esophagus Esophagus
State-of-The-Art Diagnosis State-of-The-Art Diagnosis Esophagus Esophagus
State-of-The-Art Treatment State-of-The-Art Treatment
Botulinum Toxin RFA Diet Rx REFLUX/Motility
Esophagus Esophagus
State-of-The-Art Treatment State-of-The-Art Treatment
EMR CRYO RFA TIF
Transoral incision-less funds Esophagus Esophagus
State-of-The-Art Treatment State-of-The-Art Treatment
FUNDO LINX POEMS Z-POEMS
Palatal Valve
Oral Cavity Pharynx Labial Valve UES Esophagus
LES
Pylorus
Stomach Pylorus
Stomach
Dilation Botulinum toxin Myotomy Pacing Neuromodulation Achetylcholine
AChEI
Achetylcholine
work at synapse to improve synaptic transmission DONEPEZIL
pre post
57yo 6 yrs s/p CVA
ECT
Transcranial Magnetic Stimulation Maximum Current of 800 Milliamps
Maximum Current of 2 Milliamps 65yo After Brainstem Stroke 65yo After Brainstem Stroke Post-ECT Pre-Therapy
Chev didn’t stop at the cricoid.