Laryngology
Dysphagia
Swallowing evaluation (FEES, VFSS), treatment, and rehabilitation plan.
When is dysphagia a serious problem?
Dysphagia is difficulty moving liquid or solid food from mouth to stomach. Transient dysphagia (acute tonsillitis, viral infection) is common and self-limiting. However, dysphagia lasting more than 2 weeks, causing weight loss, or with aspiration signs (cough, voice change, recurrent pneumonia) requires advanced evaluation. Causes: oropharyngeal (stroke, post-head/neck-surgery, dementia), oesophageal (reflux, achalasia, stricture, cancer), neurologic (Parkinson, multiple sclerosis, ALS). Diagnosis: FEES (Fiberoptic Endoscopic Evaluation of Swallowing) — endoscopic swallow visualisation; VFSS (Videofluoroscopic Swallow Study) — fluoroscopy with contrast. Treatment is individualised by cause.
Treatment approaches
Conservative: tongue-and-head exercises by a swallowing therapist, dilation (in pharyngeal stricture), food consistency adjustment (thick fluids, soft diet), positional techniques (chin tuck, head turn). Dietician + speech therapist + ENT partnership suffices in most cases.
Surgical: balloon dilation for oesophageal stricture; Heller myotomy or peroral endoscopic myotomy (POEM) for achalasia; diverticulectomy for Zenker diverticulum; pharyngeal surgery after head and neck cancer. Severe neurologic cases: PEG (percutaneous endoscopic gastrostomy) feeding.
Frequently Asked Questions
- Swallow pain (odynophagia) is most often from infection (pharyngitis, tonsillitis) or reflux. However, persistent unilateral odynophagia + weight loss + smoking/alcohol history warrants malignancy workup.
- No. A thin fiberoptic endoscope is passed through the nostril; local anaesthetic spray is used. 5–10 minutes. The patient is tested with various food consistencies during swallowing.
- PPI (proton pump inhibitor) for 8–12 weeks + lifestyle modification (no late meals, head elevation, weight loss, trigger-food elimination). If stricture develops, endoscopic dilation is added.
- Acute phase: nasogastric tube feeding + 2–3 daily swallow therapy sessions. Chronic phase: consistency adjustment, positional technique, diet education. 70–80% return to oral feeding by 6 months.
- Failure of lower oesophageal sphincter relaxation, causing food retention in the oesophagus. Treatment: pneumatic dilation, Heller myotomy, or POEM (peroral endoscopic myotomy).
References
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