The document discusses dysphagia, its causes (congenital, acquired, inflammatory, neoplastic, neurological, drug-induced, aging, and miscellaneous), and includes diagnostic methods such as history, physical examinations, and imaging studies. Treatments are outlined, focusing on addressing underlying causes, nutritional support, dietary modifications, swallowing techniques, and surgical options for severe cases. It highlights the importance of tailored interventions based on specific conditions affecting swallowing.

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 Dysphagia :
is difficulty in swallowing which may
affect any part of swallowing pathway
 Odynophagia :
Is sensation of pain during swallowing

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 Congenital :
* Choanal atresia
* Cleft lip & palate
* Laryngomalacia
* Unilateral vocal cord paralysis
* Laryngeal cleft
* Trachiooesophageal fistula
* Vascular rings.

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 Acquired :
1- Traumatic :
- Accidental & iatrogenic
- Blunt trauma , penetrating injuries &
compression effect .
- Direct injury & cranial nerve damage .
- Head injury .

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2- Infectious :
- Acute pharyngitis , tonsillitis , quinsy .
- Glandular fever
- Acute supraglottitis.
- Herpetic , fungal , cytomegalovirus mucosal
lesion .
- Candidiasis.
- Tuberculosis.
- Submandibular , parapharyngeal & retropharyngeal
abscess

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3- Inflammatory :
0- Gastroesophageal reflux disease + stricture
formation .
0- Patterson Brown– Kelly or Plummer ‫ــ‬ Vincent
syndrome .
0- Systemic autoimmune disorders :
scleroderma , S.L.E. , dermatomyositis , mixed
connective tissue disease , benign pemphigoid ,
Crohn’s disease .

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4- Oesophageal motility disorders :
* Achalasia.
* Diffuse oesophageal spasm .
5- Neoplastic :
* Benign & malignant tumours of the oral
cavity , pharynx , oesophagus .
* Nasopharyngeal CA.
* Skull base tumours .
* Leukaemias & lymphomas .
* Enlarged mediastinal lymph nodes .

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6- Neurological
* C.V.A.
* Isolated recurrent laryngeal nerve palsy
* Parkinson’s disease
* Multiple sclerosis .
* Myasthenia gravis .
* Motor neuron disease .

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7- Drug induced :
* drugs causing oesophagtis .
* Inhibitory drug side effects .
* Excitatory drug side effects .
* Drug complications .

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8- Aging :
* Presbydysphagia .
9- Miscellaneous :
* Foreign body in the pharynx & oesophagus .
* Caustic stricture
* Pharyngeal pouch .
* Globus pharyngeus .
* Patient with tracheostomy .
* Thyroid disease .

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History
Physical Exam
Review of systems
Imaging Studies

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 Onset , duration , severity
 Perceived level of Dysphagia
 Type of food
 F.B. sensation in throat / Globus pharyngeus
 Regurgitation (oral or nasal , timing )
 Aspiration
 weight loss
 Pain
 Hoarseness / airway obstruction
 Neck swelling
 Ear ache

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Complete E.N.T. Examination :
- Oropharyngeal
- Laryngeal
- Neck examination
Neurological Examination
Associated physical examination

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A- Laboratory test :
Hb. , S.iron binding capacity , blood film , ESR , C-reactive protein , liver fun. test ,
B. urea &elect.
B- Radiological :
♪ - Plain X-ray . Widening of prevertebral space , F.B. , vert. osteophyte , radiolucent
area (thyroid CA ) , CX-ray
♪ - Barium swallow .
♪ - Fluoroscopy : with video .
♪ - Endoscopy ( flexible / rigid ) :
- Visualizes interior of pharynx , larynx , esophagus .
- Diagnoses ulcer , tumours
- can take biopsy .
♪ - CT/MRI
- For tumours , extrinsic compression .
C- Manometry : Diagnoses motility disorders .

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Oral contrast study of
the esophagus shows
pooling of contrast
medium in the
diverticular pouch (*) in
the anteroposterior (a)
and lateral (b)
projections
b
a

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Carcinoma
Sternocleidomastoid
muscle
The axial CTscan demonstrates a mass that is completely filling
the right hypopharynx. The arrows point to an ipsilateral
lymph-node metastasis below the sternocleidomastoid muscle.

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Esophageal Squamous Cell
Carcinoma .
Esophagoscopy

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Medical Treatment
• if possible address underlying cause (e.g., iron
supplementation for Plummer-Vinson,
pyridostigmine for myasthenia gravis, benztropine
for Parkinson’s disease, antibiotics for acute
bacterial pharyngitis)
• utilize an alternative temporary route of nutrition
(nasogastric tube feeds, parenteral nutrition)

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Medical Treatment
• begin a reflux regimen (see GERD, below)
• aggressively address aspiration pneumonia
(hold oral feeds, antibiotic regimen, and
aggressive pulmonary toilet)
• Botulinum Toxin Injections: may be
considered for cricopharyngeal spasms,
inject toxin into cricopharyngeus muscle

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• change food consistencies (pureed diet
easier to tolerate initially, liquids are more
difficult to manage)
• posture techniques (chin tuck, head turn to
the poorer functioning side), palatal
prostheses, muscle strengthening exercises

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• Supraglottic Swallow :
patient voluntarily closes airway at vocal folds by
holding breath before swallow, voluntary cough after
swallow, follow with an additional swallow for
residual bolus in pharynx or pyriform
• Mendelsohn Maneuver :
voluntarily elevates and anteriorly displaces larynx to
prolong upper esophageal sphincter opening

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• Esophageal Dilation :
may be considered for achalasia (distal Lower Eso spasm), and
pharyngeal
or esophageal strictures, webs, postoperative scarring, and post
Radiation strictures
• Cricopharyngeal Myotomy :
may be considered for cricopharyngeal spasms (incomplete Upper Eso.
relaxation) or abnormal muscular contraction during relaxation
(controversial), theoretically relaxes pharyngoesophageal segment
And results in anterior elevation of larynx; complete myotomy
includes part of the lower inferior constrictor ,cricopharyngeus
muscle, and part of the Upper cervical esophagus

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• Gastric or Jejunal Feeding Tube :
temporary or permanent enteric feeding
• Vocal Fold Medialization:
for unilateral vocal fold paralysis