Oropharyngeal dysphagia

Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper esophageal sphincter. Some signs and symptoms of swallowing difficulties include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). Other symptoms include drooling, dysarthria, dysphonia, aspiration pneumonia, depression, or nasopharyngeal regurgitation as associated symptoms. When asked where the food is getting stuck patients will often point to the cervical (neck) region as the site of the obstruction. If left untreated, swallowing disorders can potentially cause aspiration pneumonia, malnutrition, or dehydration. Oropharyngeal dysphagia is going to be suspected if the patient answers yes to one of the following questions: Do you cough or choke when trying to eat? After you swallow, does the food ever come back out through your nose? A patient will most likely receive a Modified Barium swallow (MBS). Different consistencies of liquid and food mixed with barium sulfate are fed to the patient by spoon, cup or syringe, and x-rayed using videofluoroscopy. A patient's swallowing then can be evaluated and described. Some clinicians might choose to describe each phase of the swallow in detail, making mention of any delays or deviations from the norm. Others might choose to use a rating scale such as the Penetration Aspiration Scale. The scale was developed to describe the disordered physiology of a person's swallow using the numbers 1–8. Other scales also exist for this purpose. A patient can also be assessed using videoendoscopy, also known as flexible fiberoptic endoscopic examination of swallowing (FFEES). The instrument is placed into the nose until the clinician can view the pharynx and then he or she examines the pharynx and larynx before and after swallowing.