Oropharyngeal dysphagia: Clinical features, diagnosis, and management
- Anthony J Lembo, MD
Anthony J Lembo, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Nicholas J Talley, MD, PhD
Nicholas J Talley, MD, PhD
- Section Editor — Motility Disorders
- Professor of Medicine, University of Newcastle, Australia
- Adjunct Professor of Medicine and Epidemiology and Consultant, Mayo Clinic, Rochester, MN
- Adjunct Professor, University of North Carolina
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
Patients with oropharyngeal dysphagia have difficulty transferring food from the mouth into the pharynx and esophagus to initiate the involuntary swallowing process.
This topic will review the evaluation and treatment of oropharyngeal dysphagia. Our recommendations are largely consistent with the American Gastroenterological Association (AGA) guidelines on the management of oropharyngeal dysphagia (algorithm 1) . An overview of dysphagia; the etiology and evaluation of patients with esophageal dysphagia; the etiology and pathogenesis of oropharyngeal dysphagia; and the etiology, assessment, and management of swallowing disorders in palliative care populations are discussed separately. (See "Approach to the evaluation of dysphagia in adults" and "Oropharyngeal dysphagia: Etiology and pathogenesis" and "Swallowing disorders and aspiration in palliative care: Definition, consequences, pathophysiology, and etiology" and "Swallowing disorders and aspiration in palliative care: Assessment and strategies for management".)
●Dysphagia is defined as a subjective sensation of difficulty or abnormality of swallowing.
●Oropharyngeal or transfer dysphagia is characterized by difficulty initiating a swallow. Swallowing may be accompanied by nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx.
●Esophageal dysphagia is characterized by difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck. (See "Approach to the evaluation of dysphagia in adults", section on 'History' and "Approach to the evaluation of dysphagia in adults", section on 'Differential diagnosis of esophageal dysphagia'.)
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- CLINICAL FEATURES
- DETERMINING THE ETIOLOGY
- Initial evaluation
- - History
- - Physical examination
- - Laboratory testing and imaging
- Subsequent evaluation
- - Videofluoroscopic modified barium swallow
- - Nasopharyngeal laryngoscopy
- - Fiberoptic endoscopic evaluation of swallowing
- - Manometry
- Neuromuscular disorders
- - Swallowing rehabilitation and nutrition
- - Cricopharyngeal myotomy
- - Botulinum toxin injection
- - Neuromuscular electrical stimulation
- Structural disorders
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS