17th July 2023

Oropharyngeal Dysphagia

Dysphagia can be broadly split into:

• Oropharyngeal dysphagia – difficulty initiating a swallow (choking, coughing, nasopharyngeal regurgitation, aspiration, sensation of residual food in the pharynx)
• Oesophageal dysphagia – food ‘sticking’ after swallowing. This will be discussed in more depth in the diseases of the oesophagus section.

In clinical practice, it is important to try to differentiate oropharyngeal and oesophageal dysphagia in a history as they have different aetiologies and, therefore, require different investigations. Sometimes, however, patients can present with a mixed picture as some causes listed can also give an oesophageal dysphagia – particularly neurological and neuromuscular pathology.

Table 4: Causes of oropharyngeal dysphagia

Swallow assessment

• Videofluoroscopy ― anteroposterior and lateral images are taken while a patient swallows a barium solution to assess muscle coordination and detect aspiration.
• Fibreoptic Endoscopic Evaluation of Swallowing (FEES) ― allows for direct visualisation of structures as well as a functional assessment of swallowing.
• Imaging – if there is concern of extraluminal compression, e.g. MRI scan for osteophytes or soft tissue masses in the throat, or USS to assess the thyroid