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0.45  ASHA CEUs

Dysphagia Intervention for the Esophageal Zone (DIEZ): A Therapeutic Respiratory Technique for Non-Pathologic Esophageal Stasis and Globus #e314


Presenter: Roxann Diez Gross, PhD, CCC-SLP, ASHA Fellow

This course demonstrates the effects of the respiratory cycle on esophageal transport and the successful application of the DIEZ technique.


DIEZ Esophageal Therapy


"The DIEZ is the first technique or intervention I've seen in which SLPs can actually address patient complaints of globus sensation. The presenter was very informative and provided evidence-based research to educate."

– A.T., prior course participant

Read more comments about this course!

The Dysphagia Intervention for the Esophageal Zone (DIEZ) is based upon the inverse relationship between intraluminal esophageal pressures and the respiratory cycle. DIEZ is a respiratory-based therapeutic technique for improving esophageal clearance thus helping to eliminate the sensation of food sticking, regurgitation of undigested food, and non-pathologic globus sensation.

This course will fully describe how to determine who is appropriate for this therapy, how to evaluate these patients, provide instructions in how to teach the DIEZ technique to adults and children, and offer tips for making the technique habitual. Supplemental material such as patient and physician handouts are also included.

Basic esophageal and respiratory anatomy and physiology are reviewed. The manner in which the two systems functionally interact for bolus transport will be fully explained. VFSS and case studies are shown that demonstrate the effects of the respiratory cycle on esophageal transport and the successful application of the DIEZ technique. High resolution manometry with impedance is also explained and demonstrated so that learners can better understand the relative amounts and locations of esophageal pressures in relation to the respiratory cycle. The evidence presented in this course makes the case for using high lung volumes and prolonged exhalation when swallowing to address esophageal stasis and globus. This knowledge can also help to expand communication with gastroenterologists and physicians. Content is appropriate for both pediatric and adult clients.

Course is offered for 0.45 ASHA CEUs – 4.5 Contact Hours.

Course Overview – Run Time

Course Overview – Run Time: 4:36:28

  1. Introduction.
  2. Esophageal Basics.
  3. Effects of Respiratory Cycle on Esophageal Pressures.
  4. Dysphagia Intervention for the Esophageal Zone (DIEZ).
  5. Esophageal Pathology and Medical Evaluation of the Esophagus.
  6. SLP Assessment, Treatment and Goals.
  7. Case Studies.

"This presentation was one of the strongest offerings I have seen in many years. The foundation was beautifully laid, the anatomy reviewed, and the case studies each had a point!"

– K.D., prior course participant

Read more comments about this course!


DIEZ Esophageal Therapy

Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.

Content Disclosures

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Course Format

Video PowerPoint presentation with author narration & downloadable handout. Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.

Reviews

Comments From Prior Course Participants

"A technique is available for patients with continued complaint of globus when all tests have been negative. Very interesting topic presented in an easy format." T.B. (Nov. 2024)

"The DIEZ technique was beneficial. I liked all of the information." K.G. (Oct. 2024)

"The mechanics of the technique were helpful to discuss. The course was very clear and informative." L.B. (Oct. 2024)

"I felt like I couldn't help my patients with esophageal problems. But now I feel like I have something for them. I liked the explanation of anatomy and physiology." J.C. (Oct. 2024)

"I liked the organization and honesty by the presenter." K.M. (Oct. 2024)

"Actually having a treatment technique for non-pathological esophageal dysphagia will be beneficial. I enjoyed learning about the complex relationship between breathing and swallowing." C.K. (Oct. 2024)

"Step-by-step instruction for the patient and rationale for how it works. I liked the MBSS videos showing esophageal clearances, description/images of physiology, and handouts to give to patients." C.W. (Oct. 2024)

"The DIEZ is the first technique or intervention I've seen in which SLPs can actually address patient complaints of globus sensation. The presenter was very informative and provided evidence-based research to educate." A.T. (Oct. 2024)

"It was beneficial discussing how intricate respiration and swallowing are involved with each other. I liked the video examples." M.V. (Oct. 2024)

"The handout of instructions for patients is excellent. I love how it provides a rationale. Course had very functional information that you can go back and use with patients immediately." C.L. (Oct. 2024)

"Discussing how the technique benefits patient's c/o specific symptoms was beneficial. Very practical information. Can use almost right away. The speaker provided clear instructional videos/examples and provides when this technique is helpful and when it may not be." K.S. (Oct. 2024)

"This was an excellent presentation on clinical findings that have been adapted into practice for specific problems presented by patients with esophageal-related issues, i.e., belching and Globus when no other pathology is present. The course was thorough, and presented logically. I learned a lot about esophageal disorders, testing methods, and research about respiration and esophageal pressures, as well as the Diez technique." N.R. (Oct. 2024)

"Everything was beneficial because we always get patients complaining of Globus sensation. I liked all the examples." L.M. (Oct. 2024)

"I have not heard about any possible treatments for esophageal clearance, so I'm very excited to try this with my patients. I thought content was practical and will easily translate to clinical practice." K.L. (Oct. 2024)

"I work in the acute setting and encounter so many patients who complain of Globus sensation and esophageal issues, but symptoms are not reflected in diagnostic testing. I am so grateful for another strategy to promote comfort and symptom relief for these patients! I enjoyed the handouts, video of the speaker, PowerPoint slides." A.C. (Sep. 2024)

"Very practical information and readily able to be implemented. I liked the discussion on the esophageal and lung relationship." C.S. (Sep. 2024)

"Treatment options were beneficial. I liked the examples shown." R.K. (Sep. 2024)

"I loved the handouts describing DIEZ for both the patient and PCPs." L.G. (Sep. 2024)

"Use of the DIEZ approach for patients who complain of excess mucus and Globus sensation (which is almost EVERY PATIENT I SEE). It is nice to have a tool in my toolbox to try with these patients. Excellent presentation of the early literature/research behind this technique. I am sold, and I can't wait to read more about new research that looks into this very promising approach." C.A. (Sep. 2024)

"I liked the practicality and ease of reviewing this information." R.H. (Sep. 2024)

"Explanation of pathophysiology and how this technique can help to address globus. I liked the combination of data and real case scenarios." H.S. (Sep. 2024)

"Use of the DIEZ technique for those with c/o excess mucus, globus sensation, and throwing up after meals despite VFSS and GI reports being unremarkable. I liked the pacing; well thought out; good dispersement of videos throughout. I have already recommended this course to the SLP who does the VFSS at the local hospital." R.A. (Sep. 2024)

"Breathing techniques and case studies were helpful. I liked the time flexibility." V.H. (Aug. 2024)

"Discussing the technique & rationale behind it was beneficial. The presenter was engaging/interesting." P.P. (Aug. 2024)

"The DIEZ technique was beneficial as I have been looking for something to help my patient status post UPPP surgery in 2007 and has to cough out residual mucus repeatedly every day. I liked the video demonstrations and the step-by-step way you have justified why and how it makes a difference." P.S. (Aug. 2024)

"The handout was exceptional, and presentation was very good." T.S. (Aug. 2024)

"The presenter was fantastic and I loved all the visualizations and case studies to help me understand and apply. The entire presentation was great." J.M. (Aug. 2024)

"I liked the video examples, and the use of Kaypentax to measure respiration along with VFSS, HRM impedance testing for added information." K.M. (Aug. 2024)

"I liked discussing the importance of completing an esophageal screen on patients especially those who complain of dysphagia in the absence of any obvious pharyngeal difficulty. Taking it at my own pace." C.F. (Aug. 2024)

"Since I work in an adult outpatient clinic that gets a lot of referrals for voice and swallow issues, I see a LOT of patients with globus sensation. This is an invaluable strategy for me! I loved the real case examples, the MBS videos, and Roxanne's communication & teaching style. I really appreciate courses from practicing clinicians - it's so much more realistic." E.W. (Aug. 2024)

"I have already used the technique with 5 participants in our program and one staff member. All report improvement! Watching the videos was very helpful." D.H. (Aug. 2024)

"It was beneficial understanding the relationship between the pulmonary system and the esophagus. I liked the case studies and review of HRM and impedance measures." J.K. (Aug. 2024)

"I gained a better understanding of how lung volumes interact with esophageal pressures and esophageal emptying. It gives me another tool for evaluating and treating patients who complain of Globus. I liked the real world examples and step by step for how to teach the technique!" R.G. (Aug. 2024)

"I enjoyed watching and listening to SLP "in action" performing the technique during MBS! I liked all of the information! It was amazing." E.N. (Aug. 2024)

"Everything! The course was very practical with an excellent source of references." J.A. (Aug. 2024)

"The entire lecture will benefit my practice that is embedded within a laryngology clinic. We have many patients with breathing dysfunction and "GERD" that does not get better with PPIs or has been ID via instrumental testing. This gives me further motivation to spend more time on diaphragmatic breathing. RDG's presentation was one of the strongest offerings I have seen in many years. The foundation was beautifully laid, the anatomy reviewed, and the case studies each had a point!" K.D. (Jul. 2024)

"Physiology of the DIEZ technique was helpful. I liked the rate of presentation and some redundancy to drive the points home." L.K. (Jul. 2024)

"The entire presentation was beneficial! I liked the immediate usefulness of information with my current patient caseload." L.J. (Jul. 2024)

"I liked everything in this course." J.S. (Jul. 2024)

"The DIEZ technique will hopefully bring relief for many of my nursing home and short-term rehab patients. All the information was presented in an easy-to-use format. Plenty of science/research to back up the efficacy. Dr. Gross is a very good speaker and explains things well. I am excited to use this technique tomorrow at work!" G.S. (Jul. 2024)

"Using the DIEZ technique during a VFSS to assess its usefulness as a compensatory strategy was beneficial. I enjoyed the in-depth rationale as to why this technique works." B.D. (Jul. 2024)

"I liked all the information about pressure dynamics and the specific instructions for the use of the technique." C.H. (Jul. 2024)

"Implications of technique were beneficial to discuss. Good examples." B.E. (Jul. 2024)

"Everything in this course was beneficial." A.K. (Jul. 2024)

"Finally, something effective to offer patients with phlegm issues that interfere with their swallowing." L.L. (Jul. 2024)

"Pre-made patient handout was beneficial. The detailed, evidence-based nature was much appreciated." C.F. (Jul. 2024)

"Discussing the Globus sensation and providing patients with another tool was helpful. I liked how the course was logically laid out." A.T. (Jun. 2024)

"I tried it on myself when swallowing pills, and it works! I will definitely be using this with my patients who complain of a Globus sensation and have a diagnosis of GERD!! I liked the relevance and positive, practical aspect of this course!" A.V. (Jun. 2024)

"The relationship of esophageal physiology to respiration as well as the DIEZ technique was beneficial. I liked everything. Another outstanding course by Dr. Roxann Gross." R.A. (Jun. 2024)

"Viewing the MBS and the DIEZ protocol in action was helpful. I liked the explanation of the HRM." J.S. (Jun. 2024)

"I liked both the DIEZ technique and the underlying support/rationale for it working for stated clients." M.M. (Jun. 2024)

"I have many people who complain of Globus. I appreciate the explicit instructions about this technique and the extensive review of the research/evidence; this might be another option or "tool" in my toolbox for how to go about helping patients with symptom mgmt." R.Z. (Jun. 2024)

"This is a fascinating topic and I can't wait to try on my patients specifically during outpt mbs - majority are patients with c/o globus. I liked the case studies." L.E. (Jun. 2024)

"I like that this is a new horizon in dysphagia management and something possible that we can offer to the appropriate patient to potentially provide them some relief from their symptoms." K.F. (Jun. 2024)

"It was beneficial to discuss how respiration affects esophageal clearance. The course was easy to follow." M.W. (Jun. 2024)

"Excellent offering in a new technique/strategy to help clients manage their issues." K.W. (May 2024)

Course Objectives

At course conclusion, participants will be able to:

  1. Describe the pressure relationships between the esophagus and the respiratory cycle.

  2. Identify peristalsis and bolus clearance on high resolution manometry images.

  3. Demonstrate how to instruct patients in the DIEZ therapeutic technique.

  4. Identify who is appropriate for evaluation and treatment.

  5. Describe the instrumental and non-instrumental methods for pre and post treatment assessments.

Presenter & Disclosures

Roxann Diez Gross, PhD, CCC-SLP, ASHA Fellow

Roxann Diez Gross, PhD, CCC-SLP, ASHA Fellow, is a leading expert, accomplished researcher, and frequently invited national and international lecturer. Her areas of expertise include swallowing function, esophageal dysphagia, and management of patients with tracheostomy tubes and speaking valves.

Currently, Dr. Gross is a consultant and clinical specialist for Swallowing Diagnostics, Inc., Parkland, FL. She was the Director of Research at The Children's Institute in Pittsburgh, PA., and prior to this position, she was Director of the Swallowing Disorders Center at the University of Pittsburgh Medical Center and Assistant Professor of Otolaryngology in the School of Medicine.

Dr. Gross has published several scientific papers and clinical book chapters. Most recently, she was the primary editor of a case study textbook that focuses on tracheostomy and ventilator dependence in adults and children. Her primary area of research examines interactions between breathing and swallowing in neurologic and respiratory disease. Over the past 10 years, she has expanded her clinical work and research to include non-pathologic forms of esophageal dysphagia.

Speaker Disclosures:

Financial — Roxann Diez Gross is presenter of online CE courses by Northern Speech Services; receives royalties.

Nonfinancial — Roxann Diez Gross has no relevant nonfinancial relationships to disclose.

Intended Audience / Accreditation

Intended Audience/Accreditation
asha ce approved provider

This program is offered for 0.45 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • Speech-Language Pathologists

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:

  • Current ASHA Member
  • ASHA Certificate of Clinical Competence (CCC) Holder
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
  • Credentialed by a state regulatory agency to practice SLP or audiology
  • Credentialed by a national regulatory agency to practice SLP or audiology
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
  • Currently enrolled in a master's or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.

Frequently Asked Questions

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Course Completion Timeframe:

You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

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Certificate of Completion:

On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.

ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

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Purchase orders are currently not accepted for online orders, if you wish to submit a purchase order please do so at info@northernspeech.com or fax to 888-696-9655.

What is an Online Course?

Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

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Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online. Please note that courses offered for university students are not applicable for CEUs.

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Testing requirements:

Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.

Number of CEUs offered:

We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.

State licensing boards and online CEUs:

NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

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Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page. Most courses include closed captioning.

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Most of our online courses provide a link to download the accompanying handout as a PDF file. 

Group discounts:

Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.

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For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.

Course Cancellation Policy:

A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

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