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Oropharyngeal Dysphagia
Aka: Oropharyngeal Dysphagia, Dysphagia from Oropharyngeal Cause, Causes of Oropharyngeal Dysphagia
- See Also
- Dysphagia
- Esophageal Dysphagia
- Swallowing (Deglutition)
- Dysphagia after Cerebrovascular Accident
- Dysphagia Evaluation
- Dysphagia in HIV
- Dysphagia Diet
- Oral Medication Modification in Dysphagia
- Pharyngitis
- Causes: Neuromuscular Disorders
- Amyotrophic Lateral Sclerosis
- Myasthenia Gravis
- Bulbar Paralysis
- Cerebrovascular Accident
- See Dysphagia after Cerebrovascular Accident
- Parkinson Disease
- Multiple Sclerosis
- Polymyositis or Dermatomyositis
- Geriatric Degenerative Conditions
- Dementia (e.g. Alzheimer Disease)
- Frailty (Sarcopenia)
- Causes: Extra-Oral Compression From Structural Disorders
- Head and Neck Mass (see Neck Masses in Adults)
- Head and Neck Surgery or Radiation Therapy
- Zenker Diverticulum
- Cervical SpineOsteoarthritis with osteophyte related posterior pharynx compression
- Lymphadenopathy
- Thyroid Goiter
- Cricopharyngeal bar
- Causes: Medications and Toxins
- Extrapyramidal Side Effect (e.g. Tardive Dyskinesia with ChoreiformTongue movements)
- Antipsychotic Medications (e.g. Haloperidol, Risperdal)
- Other agents (e.g. Levodopa, Metoclopramide, Phenytoin, Antidepressants)
- Local Medication Effects
- See Pharyngitis Causes
- See Medication Causes of Dry Mouth
- Stomatitis (e.g. Chemotherapy or Radiation Therapy induced)
- Toxins and Metabolic Conditions
- Hepatolenticular Degeneration (Wilson's Disease)
- Botulism
- Lead Poisoning
- Chemical Intoxication (e.g. Alcohol Intoxication)
- Unknown Ingestion with Altered Level of Consciousness
- Fluoride Overdose
- Causes: Oral Conditions
- Extensive dental disease, poor Dentition or ill-fitting dentures
- Xerostomia or Dry Mouth (e.g. Sjogren's Syndrome)
- History
- See Dysphagia
- Difficulty initiating Swallowing?
- Swallowing leads to coughing or Choking?
- Swallowing with reflux into the nose or throat?
- Acute Oropharyngeal Dysphagia?
- Consider Cerebrovascular Accident
- Consider Pharyngitis
- Consider new medications with Xerostomia
- Progressive Oropharyngeal Dysphagia?
- Progressive neuromuscular disorder
- Head and Neck Mass
- Intermittent?
- Consider new medications
- Consider ill fitting dentures
- Is there difficulty with chewing?
- Chewing limited by jaw pain?
- Temporomandibular Joint Disorders
- Jaw Osteonecrosis
- Jaw Claudication (Temporal Arteritis)
- Dental Caries
- Chewing limited by Tooth Pain or malocclusion?
- Dental disease
- Ill-fitting dentures
- Chewing limited by weakness?
- Myasthenia Gravis
- Polymyositis
- Jaw Claudication (Temporal Arteritis)
- Is there liquid Dysphagia only?
- Solid Dysphagia or liquid and solid Dysphagia are more suggestive of Esophageal Dysphagia
- Are the new medications?
- Medication Causes of Dry Mouth
- Pill Esophagitis provocative medications
- Is there Unintentional Weight Loss?
- Consider head and neck malignancy
- Exam
- See Dysphagia
- General
- Cachexia or Muscle wasting (consider active malignancy)
- Frailty (Sarcopenia)
- Oropharynx
- Xerostomia
- Dentition or Dentures
- Tongue motor abnormalities (Tongue fasciculations, Tongue deviation)
- Neck
- Cervical Lymphadenopathy
- Thyromegaly or Thyroid Goiter
- Neck Mass
- Skin Exam
- Dermatomyositis findings (e.g. Gottron's Papules)
- Scleroderma findings (e.g. sausage digits)
- Neurologic Exam
- Altered Mental Status
- Transient, acute risk for Aspiration Pneumonitis
- Speech
- Weak, breathy or dysarthric in various neurologic and neuromuscular disorders
- Swallowing
- Coughing or Choking when Swallowing (Oropharyngeal Dysphagia)
- Focal Motor Weakness
- Cerebrovascular Accident
- Generalized Motor Weakness
- Myasthenia Gravis (Ptosis, Diplopia, Dysarthria)
- Cranial Nerves
- Eyelid Ptosis
- Gag Reflex loss (CN 9 and CN 10)
- Facial or Tongue neurologic deficits (CN 5, CN 7, CN 12)
- Evaluation: Screening Tools
- Eating Assessment Tool or EAT-10 (Nestle)
- https://www.nestlehealthscience.com/health-management/gastro-intestinal/dysphagia/eat-10
- Belafsky (2008) Ann Otol Rhinol Laryngol 117(12):919-24 +PMID:19140539 [PubMed]
- What About Swallowing?
- See Dysphagia
- Standard Dysphagia history is as effective as EAT-10 questionnaire
- Heijnen (2016) Dysphagia 31(2):214-22 +PMID:26753926 [PubMed]
- Swallowing Quality of Life Questionnaire (SWAL-QOL)
- Requires purchase of Questionnaire
- Sidney Swallow Questionnaire
- https://stgeorgeswallowcentre.org/sydney-swallow-questionnaire/
- Dwiveldi (2010) Oral Oncol 46(4):e10-4 +PMID:20219415 [PubMed]
- Evaluation: Diagnostics
- See Swallowing Evaluation for Oropharyngeal Dysphagia
- Undiagnosed Dysphagia and silent aspiration is common in the frail elderly
- Consider in those with prior Cerebrovascular Accident, Dementia or Neuromuscular Disorder
- Avoid over-aggressive treatment and dietary restrictions
- Educate patient and their family on findings on options for management
- Discuss risks and benefits of interventions
- Tailor management to patient preferences
- Management
- Optimize meal schedule and eating environment to best suit the needs of the patient
- Eat mindfully
- Avoid foods that are more likely to cause Dysphagia
- Cut food into small pieces
- Eat slowly, with smaller bites and chew carefully
- Frequently drink liquids to dilute food bolus consistency
- Adding sauce to food may lubricate food bolus and allow easier Swallowing
- Dietary changes
- See Dysphagia Diet
- Mechanical Soft Diet
- Indicated in chewing weakness or poor Dentition
- Modified Consistency Diet (thickened foods and liquids that slow transit)
- Indicated in impaired Swallowing
- Pureed Diet
- Indicated in chewing weakness, poor Dentition or Xerostomia
- Swallowing Rehabilitation
- Muscular reconditioning Exercises
- Exercises to stengthen jaw, lips and Tongue in clinically stable patients with learning potential
- Compensatory safe Swallowing techniques (repositioning maneuvers)
- Eat while in upright position
- Chin-Tuck Maneuver
- Indicated in patients with aspiration risk due to stroke or neuromuscular disorder
- Directs food posteriorly, reducing the risk of aspiration
- Saconato (2016) Int Arch Otorhinolaryngol 20(1): 13-7 [PubMed]
- Head-Turn Maneuver
- Indicated in patients with Unilateral Weakness
- Turn head toward weak side
- Gravity directs food toward the stronger side
- Enteral Feeding
- Consider alternatives and follow patient wishes after education on choices
- Consider Palliative Care or hospice Consultation
- Careful hand feeding
- Non-invasive alternative to PEG Tubes with similar efficacy and safety
- DiBartolo (2006) J Gerontol Nurs 32(5):25-33 [PubMed]
- Nasogastric Tube
- Allows for acute nutrition and medication administration in the first week after Cerebrovascular Accident
- Percutaneous Endoscopic Gastrostomy (PEG)
- Allows for the longterm Oropharyngeal Dysphagia management in severe Dysphagia
- Does not reduce aspiration risk or decrease mortality
- Teno (2012) J Am Geriatr Soc 60(10): 1918-21 [PubMed]
- Complications
- Aspiration Pneumonia
- Geriatric Failure to Thrive
- Dehydration
- Malnutrition
- References
- Roden (2013) Otolaryngol Clin North Am 46(6): 965-87 [PubMed]
- Vose (2014) Curr Phys Med Rehabil Rep 2(4): 197-206 [PubMed]
- Wilkinson (2021) Am Fam Physician 103(2): 97-106 [PubMed]