Oropharyngeal dysphagia
A swallowing disorder causing difficulty moving material from the oropharynx to the esophagus.
Oropharyngeal dysphagia happens when a person cannot clear material from the oropharynx into the esophagus because of a problem near the esophagus. How it shows up depends on the specific cause and the type of symptoms. People with this condition may feel food sticking in the throat, cough or choke, lose weight, have repeated chest infections, or bring food back up. Studies of the general population estimate that between 2 and 16 percent of people have oropharyngeal dysphagia, though this number changes based on the underlying cause, the person’s age, and their environment.
Signs and symptoms include trouble controlling food or saliva in the mouth, difficulty starting a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, a gurgly or wet voice after swallowing, food coming back through the nose, and the patient’s own complaint of swallowing trouble. Other possible signs are drooling, slurred speech, voice changes, aspiration pneumonia, depression, or regurgitation into the nose. When asked where food gets stuck, patients often point to the neck area.
If left untreated, swallowing disorders can lead to aspiration pneumonia, malnutrition, or dehydration.
Doctors suspect oropharyngeal dysphagia if a patient answers yes to either of these questions: Do you cough or choke when trying to eat? After you swallow, does food ever come back out through your nose? The main test is a modified barium swallow (MBS), where the patient is fed different consistencies of liquid and food mixed with barium sulfate by spoon, cup, or syringe, and the swallow is filmed with videofluoroscopy. Clinicians then evaluate and describe the swallow. Some describe each phase in detail, noting delays or abnormalities; others use a rating scale like the Penetration Aspiration Scale, which scores the swallow from 1 to 8. Other scales exist as well. Another assessment is videoendoscopy, also called flexible fiberoptic endoscopic examination of swallowing (FFEES). A scope is placed through the nose to view the pharynx and larynx before and after swallowing, though the camera is blocked during the actual swallow. A rigid scope placed in the mouth can also be used, but it prevents the patient from swallowing.
Quick Facts
- Field
- Gastroenterology, ENT surgery
- Complications
- Aspiration, chest infection, malnutrition, dehydration, and death.
- Causes
- Stroke, head trauma, neurodegenerative diseases, muscular or neuromuscular disorders, and local or structural lesions.
- Diagnosis
- Clinical swallow assessment, videofluoroscopy, fibreoptic endoscopic evaluation of swallowing, High-resolution manometry, Functional Lumen Imaging Probe, and accelerometry.
- Differential
- Esophageal dysphagia and Globus sensation.
- Treatment
- Dietary modification, manipulation of swallowing posture, or swallowing technique, thickening agents, enteral tube feeding, surgical management, and botulinum toxin injection
- Frequency
- 6–50%
Facts from the source article.
Lore & Background
Oropharyngeal dysphagia arises from various underlying pathologies, including neurological disorders such as stroke, Parkinson's disease, amyotrophic lateral sclerosis, Bell's palsy, and myasthenia gravis, which can weaken facial and lip muscles involved in mastication and swallowing. Mechanical obstructions like malignancies, cervical rings, or Zenker's diverticulum, as well as conditions like xerostomia from Sjögren syndrome or medication side effects, also contribute. Diagnosis is suspected if patients report coughing or choking when eating or food coming back through the nose, and is confirmed via Modified Barium swallow with videofluoroscopy or flexible fiberoptic endoscopic examination of swallowing (FFEES).
Reader's Guide
Oropharyngeal dysphagia is significant because it can lead to serious complications like aspiration pneumonia, malnutrition, and dehydration if untreated. Its management involves a range of treatments including thickening agents, postural techniques (e.g., chin down, head rotation), swallowing maneuvers (e.g., supraglottic swallow, Mendelsohn maneuver), and medical devices for isometric tongue exercises. Diet modifications, such as soft or liquid diets, may also be warranted. The condition's prevalence varies widely, and its differential diagnosis includes numerous neurological, structural, and iatrogenic causes, underscoring the need for careful clinical evaluation.
Did You Know?
- Oropharyngeal dysphagia prevalence in the general population ranges from 2 to 16 percent.
- A Modified Barium swallow uses different consistencies of liquid and food mixed with barium sulfate, imaged via videofluoroscopy.
- The Penetration Aspiration Scale uses numbers 1–8 to describe disordered swallowing physiology.
- Postural techniques like chin down can help when there is a delay in initiating the swallow.
More in Symptoms and signs: Digestive system and abdomen 1-24
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