Dysphagia Due to Non-Hodgkin’s Lymphoma after Radiation: A Case Report of Rehabilitation Management

Abstract

: A 63 years old female was consulted to Dysphagia Clinic in Medical Rehabilitation Department six months after 20 times radiation with total dose 40Gy due to Non-Hodgkin’s Lymphoma (NHL). She complained about difficulty in swallowing, dry saliva, and inadequate coughing. First Flexible Endoscopic Evaluation of Swallowing (FEES) indicated that she had oropharyngeal neurogenic dysphagia with risk of post swallowing aspiration and Functional Oral Intake Scale (FOIS) was 1 with tube dependent without oral intake. She got 12 times Neuromuscular Electrical Stimulation (NMES) in suprahyoid and infrahyoid muscle for 60 minutes and biofeedback 2times/week, breathing and oromotor exercises, Mendelsohn maneuver, Masako and Shaker Exercise. After 2 months of intensive rehabilitation, the second FEES showed a progression that patient might swallow semi-solid food with repeated swallowing, FOIS was 2 with tube dependent with minimal oral intake and after 5 months continued with oromotor and swallowing exercises FOIS was 3 with tube supplements with consistent oral intake. QoL was assessed with M.D. Anderson Dysphagia Questionnaire, result was improving from 53,68 to 70. Comprehensive rehabilitation management for dysphagia due to HNC after radiation can improve swallowing function, safety oral intake, and enhance QoL