Oropharyngeal dysphagia
Inability to transfer material from oropharynx to esophagus.
When the throat can't move food or liquid into the esophagus due to a nearby dysfunction, it's called oropharyngeal dysphagia. Symptoms vary based on the cause, and studies of the general population estimate its frequency between 2 and 16 percent.
Quick Facts
- Field
- Gastroenterology, ENT surgery
- Complications
- Aspiration
- chest infection
- malnutrition
- dehydration
- and death.
- Differential
- Esophageal dysphagia and Globus sensation.
- Frequency
- 6–50%
Facts from the source article.
Signs and symptoms
Swallowing problems can show up as trouble managing food or spit in the mouth, a hard time starting a swallow, coughing, choking, repeated pneumonia, weight loss for no clear reason, a wet or gurgly voice after swallowing, liquid coming out the nose, or a patient’s own report of difficulty. Other signs include drooling, slurred speech, a changed voice, pneumonia from inhaling, depression, or fluid backing into the nose. People often point to their neck when asked where food sticks. Without care, these issues may cause pneumonia from aspiration, malnutrition, or dehydration.
Diagnosis
Oropharyngeal dysphagia is suspected if a patient answers yes to coughing or choking when trying to eat or to food coming back out through the nose after swallowing. A Modified Barium swallow (MBS) is commonly used: different consistencies of liquid and food mixed with barium sulfate are fed by spoon, cup, or syringe and x-rayed using videofluoroscopy. Clinicians may describe each phase of the swallow in detail or use a rating scale such as the Penetration Aspiration Scale (numbers 1–8). Other scales also exist. Videoendoscopy, or flexible fiberoptic endoscopic examination of swallowing (FFEES), involves placing an instrument into the nose to view the pharynx and larynx before and after swallowing; the camera is blocked during the actual swallow. A rigid scope placed into the oral cavity can also be used but prevents swallowing. Less frequent assessments include imaging studies, ultrasound, scintigraphy, electromyography (EMG), electroglottography (EGG), cervical auscultation, and pharyngeal manometry. Stroke can cause pharyngeal dysfunction with high aspiration occurrence; normal swallowing may or may not return after an acute phase of about 6 weeks. Parkinson's disease can cause multiple prepharyngeal, pharyngeal, and esophageal abnormalities, with severity often correlating with swallowing disorder severity. Neurologic disorders such as stroke, Parkinson's disease, amyotrophic lateral sclerosis, Bell's palsy, or myasthenia gravis can cause weakness of facial and lip muscles involved in mastication and swallowing. Oculopharyngeal muscular dystrophy is a genetic disease with palpebral ptosis, oropharyngeal dysphagia, and proximal limb weakness.
Treatment
Thickening agents can improve swallowing in pediatric populations. Postural techniques include head back (extension) for inefficient bolus movement from the front of the mouth; chin down (flexion) for delayed swallow initiation or weak tongue base; head rotation to the damaged or weaker side with chin down for inadequate airway protection; lying down on one side for reduced pharyngeal contraction causing excess residue; head rotation to the damaged or weaker side for unilateral pharyngeal paralysis or paresis; and head tilt to the stronger side for unilateral oral and pharyngeal weakness. Swallowing maneuvers include the supraglottic swallow (breath hold, swallow, then cough) for reduced or late vocal fold closure or delayed pharyngeal swallow; the super-supraglottic swallow (tight breath hold with bearing down, swallow, then cough) for reduced airway closure; the effortful swallow (squeezing muscles tightly while swallowing) for reduced posterior tongue base movement; and the Mendelsohn maneuver (holding the Adam's apple up during a swallow) for reduced laryngeal movement or discoordinated swallow. A medical device may also be used.
More in Symptoms and Signs: Digestive System and Abdomen
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