Dysphagia
Summary of the lecture from Dr. Ryan Winters via HMRI ENT update 2023
Dysphagia
Pathology can be anywhere from lips to stomach
A sensation of sticking in the throat/neck/chest
Prolonged swallowing sensation
Inability to swallow
Present in 20% of the population and >60% of nursing home residents
Swallowing
Swallowing centre in the medulla, floor of 4th ventricle
Connected to emetic and respiratory centres in the brainstem
Swallowing is both voluntary and involuntary
Swallos 600 times per day
Oropharyngeal phase (voluntary)
Oesophageal (involuntary)
Categories
Neurological
Structural
History
Differentiate neurological versus structural
Oral/pharyngeal versus oesophageal
Onset
Duration
Sudden versus gradual
Progressive versus intermittent
Triggers
Solids versus liquids
Specific foods
Inciting event (Stroke, illness)
Lifestyle
Weight loss = red flag
Needing to chew food more
Taking longer to eat a meal
Drooling or dry mouth
Associated
Coughing or choking
Regurgitaiton
Heartburn
Change of voice
Odynophagia = Bad
Otalgia = Bad
Neck mass = Bad
PMHx
GORD
Neurological disease
Diabetes
XRT, CTx
Neck surgery
Immunosuppressants
Smoking and alcohol = cancer
Exam:
Oral cavity
Asymmetry is more worrying
Neck exam
Neck mass
Lymphadenopathy
Risk of cancer
Isolated dysphagia rarely HN cancer but can be oesophageal cancer
Dysphagia + worsening dysphonia, palpable neck mass = Bad
Risk
HN cancer = 1% of all
Oesophageal = 2% of all
HaNC-RC risk calculator
Dysphagia with risk factors
One study of rapid access dysphagia clinic
40% GORD
10% Stricture
11% Oesophageal malignancy
10% dysmotility
0% HN Cancer
Triage
Dysphagia only = Gastro and MBBS
Dysphagia and other complaints = ENT and MBSS
Barium Swallow
MBSS = Modified Barium Swallow Study
Water soluble contrast sufficient as barium shortage
Management
Normal MBSS
Reassure
Manage GORD
SP
Abnormal MBSS
Pharyngeal pouch = ENT referral
All other pathology = Gastro referral
Cricophrayngeal dysfun, stricture, etc
References:
Dysphagia - HNE Pathways
HaNC-RC risk - Risk tool
