DYSPHAGIA

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DYSPHAGIA

• Mr Andrew Lale
• Consultant ENT surgeon

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SWALLOWING

• 5 minute consultation
• CAUSES
• Acute
• Neurogenic
• Globus pharyngeus
• Laryngopharyngeal reflux
• Strictures and narrowing
• Pharyngeal Pouches

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CONSULTATION

• True Dysphagia or feeling of a lump?
• Dysphagia for what?
• Regurgitation or Aspiration?
• Gastro-oesophageal reflux current or past?
• Change of Diet or weight loss?
• Odynophagia

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ACUTE DYSPHAGIA

• History FB. Previous problems.
• Examination Drooling. Pain. Pyrexia. Odynophagia
• Treatment
• Food bolus Buscopan, fizzy drink, refer at 1
  hour
• FB Refer

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Foreign bodies
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Strictures and narrowing

• Malignant/benign
• Cricopharyngeal bar
• C-spine osteophytes
• Kyphosis
• Post cricoid web

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Cricopharyngeal bar
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Osteophytes
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Neurogenic

• CVA
• Motor neurone disease
• Multiple Sclerosis
• Parkinsons disease
• Myaesthena gravis

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GLOBUS PHARYGEUS

• Previously Globus Hystericus
• Worse when NOT eating or drinking
• No true dysphagia solids/liquids
• No odynophagia
• No reguritation/aspiration
• Variable history. ?exclude reflux..

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Laryngopharyngeal Reflux (LPR)

• Reflux of gastric acid to larynx/pharynx
• May be silent
• Symptoms include feeling of a lump,
  odynophagia/chronic sore throat, chronic cough
  (especially nightime), hoarse voice and mucous
  in throat.

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LPR Investigations

• Nasopharyngoscopy, red post cricoid region.
• ? Barium swallow?
• Oesophageal pH manometry

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LPR treatment

• 6 weeks PPI Gaviscon initially
• At review further 6 weeks treatment if improving
• General laryngeal hygiene measures
• If no better, rigid pharyngo-oesophagoscopy
• pH manometry ?fundoplication

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Pharyngeal pouches

• HISTORY
• Long Hx dysphagia
• Regurgitation esp at night
• gurgling swallow
• Aspiration (recurrent pneumonia)
• Weight loss and change in Diet.

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Pharyngeal Pouches

• EXAMINATION
• Nasopharyngoscopy might show pooling
• Unlikely to feel anything in neck
• Barium swallow

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Pharyngeal pouches

• TREATMENT
• Surgical if fit for GA
• (External approach)
• Endoscopic stapling, low morbidity and high
  success rate.

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Pouches
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Pouches
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Summary Fast track patients

• Young male patient
• Short history
• Odynophagia
• Smoking and Alcohol
• Weight loss
• Aspiration and reguritation

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Summary Globus patients

• Variable history
• No true dysphagia
• Young female
• No weight loss
• Associated anxiety

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Summary Pouch patients

• Older male/female
• REGURGITATION
• Gurgling swallow
• Recurrent chest infections
• Weight loss

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Thankyou