Dysphagia - Swallowing Disorders

Dysphagia is a swallowing disorder that manifests as pain or discomfort during swallowing, the inability to swallow solids and/or liquids, and finally with symptoms related to the aspiration of food into the lungs.

The Swallowing Mechanism

It generally includes three phases:

• Oral phase, during which food in any form is prepared to be swallowed through chewing by the teeth, lubrication by saliva, and movement by the tongue.
• Pharyngeal phase, which channels food into the esophagus in a way that protects the larynx from food and thus prevents its entry into the lungs (aspiration).
• Esophageal phase, with the esophagus receiving the food and channeling it to the stomach for digestion to follow.

Any disorder in the first two phases is called Oropharyngeal Dysphagia and is the subject of study in Otolaryngology. The third phase is the subject of study in Otolaryngology and, mainly, Gastroenterology.

Interdisciplinary Approach

Other medical specialties that also participate in the study and treatment of swallowing disorders include:

• Pulmonology (due to the consequences of aspiration on the lungs)
• Neurology
• Radiology
• Psychiatry in some cases
• General Surgery

Others who will also work with a patient presenting a swallowing disorder include Speech Therapists, Dentists, Dieticians, and perhaps Psychologists.

Examination Methods

A patient with a swallowing disorder may or may not suffer from other diseases, which is why they should initially be evaluated by an Internist who will diagnose whether their problem is part of a general disease or a local problem.

The Specialist will evaluate information from the medical history, the description of the problem by the patient or their relatives, and the duration of the problem. Depending on the symptoms and findings, evaluations may possibly be requested from other specialties such as Neurology, Psychiatry, Gastroenterology, etc.

The special examinations required, depending on the patient, are:

• Endoscopic Swallowing Evaluation
• Special Radiological examinations (performed in specialized centers)
• CT Scan
• Gastroenterological examinations (pH-metry, manometry, gastroscopy, etc.)

For most patients with swallowing disorders, the diagnosis of the problem can now be safely and certainly established, followed by appropriate treatment.

Treatment

Treatment depends on the diagnosis and can be surgical, pharmaceutical, or conservative with specific exercises, changes in body position during swallowing, and training to learn swallowing techniques.

Endoscopic Evaluation of Swallowing

(Fiberoptic Endoscopic Evaluation of Swallowing - FEES)

This is a special and easy examination performed in the office or at the bedside of patients who cannot be moved. With a little local anesthesia in the nose, we pass a thin tube (Endoscope) through which we observe the patient's pharynx as they swallow various colored foods. The examination is recorded on video so we can study the problem together with the patient, giving appropriate instructions or deciding on further evaluation.