Oropharyngeal dysphagia: manifestations and diagnosis

Abstract

Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study

“…In spite of these adjustments in the oral diets of the residents, they were still at a higher risk of aspiration. This finding confirms that nursing home residents with dysphagia are at a higher risk of pneumonia, which has been shown by previous studies [12, 14, 51, 52]. …”

Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

“…These investigators studied children utilizing high resolution esophageal pressure topography, impedance, and videofluoroscopy methods 3,49–53 . Notable works that may translate to the neonatal population include: 1) assessment of oropharyngeal dysphagia and aspiration utilizing pressure-flow analysis, a method to assess swallowing physiology by detecting motor function, bolus flow and transit, and correlation with symptoms, 54–58 and 2) development a bolus residue scale to detect pharyngeal retention 59 .…”

Oropharyngeal dysphagia profiles in individuals with oculopharyngeal muscular dystrophy

“…Dysphagia can be broadly classified by impairments in swallowing efficiency and safety. Swallow inefficiency refers to incomplete bolus clearance and contributes to weight loss and malnutrition while impairments in airway safety result in aspiration, or material entering the trachea, contributing to significant pulmonary sequelae . In addition to physiologic changes in swallow function, swallowing‐related quality of life is moderately impacted characterized by prolonged meal‐time durations and increased burden .…”