Overview of Dysphagia: Difference between revisions
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#* radiotherapy | #* radiotherapy | ||
# Inappropriate laryngeal closure | # Inappropriate laryngeal closure | ||
# Weakness or paralysis of the thyropharyngeal contraction | |||
# Cricopharyngeal dysmotility | |||
# Idiopathic spasm of the cricopharyngeal muscle | |||
=== Clinical Presentation === | |||
=== Oesophageal Dysphagia === | === Oesophageal Dysphagia === | ||
Revision as of 19:51, 27 June 2024
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Introduction[edit | edit source]
Swallowing (deglutition) impairment effects individual's safety and efficacy during drinking or eating. The consequence of deglutition difficulties are malnutrition, dehydration, and increase the risk of aspiration pneumonia. Additionally, dysphagia has a significant impact on social and psychological well-being because eating and drinking are important social and pleasurable activities. Understanding dysphagia helps with its early detection and management and lead to reduction in patient's hospital stay, improvement in rehabilitation outcomes, and decreasing morbidity and mortality.This course discusses dysphagia as a dysfunction of one or more parts of the swallowing apparatus.
Definition[edit | edit source]
Dysphagia is defined as the difficulty or impossibility to swallow liquids, food or medication and can occur during the oropharyngeal or the oesophageal phase of swallowing.[1]
Oropharyngeal Dysphagia[edit | edit source]
Oropharyngeal dysphagia is characterised by inability to initiate the swallow process.[2]
Oropharyngeal dysphagia is associated with abnormalities in the structures (structural alterations) in the oral cavity and the pharynx[2] , or it may result from functional disorder of deglutition.[1]
Structural alterations effects bolus progression. The following abnormalities can lead to oropharyngeal dysphagia:
- oesophageal and ENT tumors
- neck osteophytes
- post surgical oesophageal stenosis
- as a complication following head & neck cancer
The normal swallow response in healthy humans ranges form 0.6–1 s. Functional disorder of deglutition affects oropharyngeal swallow response. It can be caused by:
- ageing
- stroke
- systemic or neurological diseases
Occurrence[edit | edit source]
The prevalence of oropharyngeal dysphasia varies as it depends on the screening method and the type of population tested. Symptoms may be often neglected by a patient or a caregiver and not reported to the physician.[1]Percentage of patients with oropharyngeal dysphasia is high and include:[3]
- over 30% of patients with a cerebrovascular accident
- 52%–82% of patients with Parkinson’s disease
- 84% of patients with Alzheimer’s disease
- up to 40% adults aged 65 years and older
- more than 60% of elderly institutionalised patients
Mechanisms[edit | edit source]
- Velopharyngeal incompetence occurs when " velum and lateral and posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech and deglutination."[4] It can be caused by:[3]
- vagus nerve and pharyngeal plexus impairment due to neurological and neurosurgical conditions
- brainstem stroke
- decompression of the foramen magnum
- head and neck cancer treatment due to intentional or inadvertent damage of the nerve supply to the palatal muscles [5]
- tumours of the oropharynx
- radiotherapy to the nasopharynx
- Absent, inefficient, or infrequent laryngeal elevation takes place when the thyrohyoid and suprahyoid muscles fail to assist with anterior and superior movement of the hyolaryngeal complex. As a result, the cricopharynx does not relax. This pathology arises with the following neurological and neurosurgical conditions:
- posterior circulatory stroke
- cerebellopontine angle surgery
- high level spinal injuries or tumours
- head and neck cancer surgery with removal of suprahyoid musculature and its nerve supply
- floor of mouth resection
- radiotherapy
- Inappropriate laryngeal closure
- Weakness or paralysis of the thyropharyngeal contraction
- Cricopharyngeal dysmotility
- Idiopathic spasm of the cricopharyngeal muscle
Clinical Presentation[edit | edit source]
Oesophageal Dysphagia[edit | edit source]
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Thiyagalingam S, Kulinski AE, Thorsteinsdottir B, Shindelar KL, Takahashi PY. Dysphagia in older adults. InMayo clinic proceedings 2021 Feb 1 (Vol. 96, No. 2, pp. 488-497). Elsevier.
- ↑ 2.0 2.1 Banerjee S. Overview of Dysphagia. Plus Course 2024
- ↑ 3.0 3.1 Rofes L, Arreola V, Almirall J, Cabré M, Campins L, García-Peris P, Speyer R, Clavé P. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology research and practice. 2011;2011(1):818979.
- ↑ Johns DF, Rohrich RJ, Awada M. Velopharyngeal incompetence: a guide for clinical evaluation. Plast Reconstr Surg. 2003 Dec;112(7):1890-7
- ↑ Menon JR. Pharyngeal Dysphagia. Int J Head Neck Surg 2022;13(1):55-61.
