History

The patient history is extremely important in the evaluation of oropharyngeal dysphagia, and is usually sufficient to answer the first two questions regarding the

Structural

• Barium swallow

Functional

• Underlying neuromuscular disease

• Videofluoroscopic swallowing

Structural

• Zenker's diverticulum

• Cricopharyngeal bar

• Neoplasm

• Web

• Osteophytes

• Postsurgical

• Post-radiation

• Chemotherapy mucositis

• Corrosive

• Infection

>

• Guillain-Barre

• Cerebral palsy

Myogenic

• Myasthenia gravis

• Polymyositis

• Oculopharyngeal-muscular dystrophy

• Paraneoplastic

• Myotonic dystrophy

• Sarcoidosis

Treatment

• Osteophyte

• Swallowing therapy

Treatment

• Treat underlying disease

• Swallowing therapy

• Gastrostomy feeding

FIGURE 8-1 Management algorithm for oropharyngeal dysphagia. ALS = amyotrophic lateral sclerosis; CVA = cerebral vascular accident; ENT = ear, nose, and throat; MS = multiple sclerosis.

presence and location of dysphagia. Major objectives of the history are to first determine if dysphagia is present and then to differentiate oropharyngeal dysphagia from esophageal dysphagia. In cases of oropharyngeal dysphagia, patients are able to accurately localize bolus hang-up in the neck; however, they mistakenly identify the neck as the locus of bolus hang-up with esophageal dysphagia about 15 to 30% of the time. Therefore, obtaining a history of symptoms such as aspiration, coughing, nasopharyngeal regurgitation, or drooling is of significant value in distinguishing oropharyngeal dysphagia from esophageal dysphagia. Distinguishing oropharyngeal dysphagia from globus sensation may be difficult. Unlike dys-phagia, which occurs only during swallowing, globus sensation is a constant sensation of a foreign body present in the throat. If the history is consistent with globus and evaluation with radiographic and endoscopic examinations are negative, most patients with globus respond to explanation and reassurance.

Constipation Prescription

Constipation Prescription

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