Investigative Techniques in the Assessment of Oral-Pharyngeal Dysphagia

Abstract

Oral-pharyngeal dysphagia is a common problem with a high morbidity and mortality. In general, it is not managed as well as esophageal dysphagia by gastroenterologists. A number of techniques are now available for the assessment of oral-pharyngeal dysphagia. However, a careful clinical assessment followed by a video barium swallow is all that is required for the diagnosis and management in the majority of patients. Pharyngeal manometry is likely to play an increasingly important role in the assessment of difficult or atypical cases in whom it can provide functional information not achievable with videoradiography alone. Videolaryngoscopy is a quick and simple way of detecting structural lesions and of assessing deglutitive airway protection. Videolaryngoscopy is non-invasive and easily performed in an office setting. Ultrasonography is a convenient way of assessing lingual function, but provides no more information than the video barium swallow. Pharyngeal scintigraphy is likely to assume a greater clinical relevance as a means of quantifying swallow efficiency and response to therapy.

Oropharyngeal Scintigraphy: A Reliable Technique for the Quantitative Evaluation of Oral–Pharyngeal Swallowing

“…However, a significant limitation of videofluoroscopy is its inability to quantify precisely the completeness of swallowed bolus transfer from the oral and pharyngeal cavities [5,6]. Scintigraphic transit measures have been validated in the esophagus [7][8][9][10][11][12], but the technique has received little attention in the study of the oral-pharyngeal phase of the swallow [13][14][15][16][17][18][19]. In particular, there has been little attention paid to the measurement of regional clearance of the swallowed bolus [16,[19][20][21][22][23][24].…”

Durchführung und Interpretation der Ösophagusmanometrie: Empfehlungen der Deutschen Gesellschaften für Neurogastroenterologie und Motilität (DGNM), für Verdauungs- und Stoffwechselerkrankungen (DGVS) und für Allgemein- und Viszeralchirurgie (DGAV)

“…Im Vergleich zum UÖS ist die Relaxationszeit mit 0,3 bis 0,5 Sekunden sehr kurz. Nach der Relaxation folgt ein Druckanstieg von zumindest 20 bis 40 mmHg, der etwa 2 bis 4 Sekunden andauert [38,49,73,74]. Zur Relaxation des OÖS kommt es nicht nur beim Schluckakt, sondern auch bei einer Ösophagusdistension (Relaxation im Rahmen des Aufstoß-Reflexes).…”

Sample‐based approaches to decision making problems under uncertainty

“…The upper esophageal sphincter (UES) is a complex structure composed of the cricopharyngeus, the inferior constrictor, and the proximal cervical esophagus. Dysphagia from dysfunction of the UES is a primary cause of oropharyngeal dysphagia that can cause significant morbidity 13–17. Isolated cricopharyngeal spasm is a difficult entity to treat.…”