6 Facts About Oropharyngeal Dysphagia

The swallowing complications of a dysphagia diagnosis are typically pinpointed within two types of anatomical occurrences: oropharyngeal (“high dysphagia”), relating to a neurological problem in the mouth and/or throat; or esophageal (“low dysphagia”), relating to a physical problem in the esophagus, often aggravated by a blockage or irritation.1

Exploring and analyzing the etiology and pathogenesis specific to oropharyngeal dysphagia (OPD) within palliative care populations has revealed key determinations related to this swallowing disorder2, including:

1. The oropharyngeal process is classified as the active phase of swallowing. This complex action includes the initiation of the swallow, squeezing food and/or substances toward the thoracic region, and sealing the airway to prevent food or liquid from entering the airway (resulting in aspiration), and/or to prevent choking.3

2. OPD defined. Oropharyngeal dysphagia encompasses problems with the oral preparatory phase of swallowing (chewing and preparing the food), oral phase (moving the food or fluid posteriorly through the oral cavity with the tongue into the back of the throat) and pharyngeal phase (swallowing the food or fluid and moving it through the pharynx to the oesophagus).4

3. OPD is characterized by difficulty initiating a swallow. This initial challenge often corresponds with aspiration, nasopharyngeal regurgitation, and a sensation of residual food remaining in the pharynx.5

4. OPD frequently occurs after thoracic surgery procedures. According to one recent study, patients particularly at risk include those subjected to preoperative tobacco abuse, gastroesophageal reflux, and cardiopulmonary bypass procedures.6

5. Fiber-optic endoscopy and videofluoroscopy have become the OPD diagnostic “gold standard.” These technologies are typically applied to measure the success/fail rate of oropharyngeal dysphagia therapy. Additional diagnostic applications and practices include an evaluation of clinical assessments such as dysphagia severity ratings or dietary status.7

6. OPD affects patients of all ages. Although prevalent in the elderly, OPD is also well-documented in demographics aged 18-45, as well as adolescents less than 18. Children, particularly those afflicted by neuro disorders such as cerebral palsy, can be susceptible to OPD and its effects.8

Understanding the health ramifications of OPD is critical for preventative and ongoing treatment protocols.9 Ongoing research will provide better clinical understanding concerning what common approaches may be applied as both short- and/or long-term remedies for the swallowing disorder.10

 

  1. Dogan I, Puckett JL, Padda BS, Mittal RK. Prevalence of increased esophageal muscle thickness in patients with esophageal symptoms. Am J Gastroenterol 2007; 102: 137–45.
  2. Mittal RK, Ren J, McCallum RW, Shaffer HA Jr, Sluss J. Modulation of feline esophageal contractions by bolus volume and outflow obstruction. Am J Physiol 1990; 258: G208–15.
  3. Huckabee M. Application of EMG biofeedback in the treatment of oral pharyngeal dysphagia. Biofeedback Foundation of Europe website. Available at: http://www.bfe.org/protocol/pro06eng.htm. Published 1997. Accessed August 13, 2013.
  4. Morgan AT, Dodrill P, Ward EC. Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev. 2012 Oct 17;10:CD009456. doi: 10.1002/14651858.CD009456.pub2.
  5. Ibid.
  6. Restive D, Marchese-Ragona R, Lauria G, Squatrito S, Gullo D, Vigneri R. Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy. Diabetes Care. 2006 Dec;29(12):2650-3. Available at: http://care.diabetesjournals.org/content/29/12/2650.short . Accessed August 13, 2013.
  7. Ibid.
  8. Morgan AT, Dodrill P, Ward EC. Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev. 2012 Oct 17;10:CD009456. doi: 10.1002/14651858.CD009456.pub2.
  9. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a New Clinically Relevant Classification by High-Resolution Manometry. Gastroenterology 2008; 135: 1526–33.
  10. Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with dysphagia. Am J Gastroenterol 2011; 106: 349–56.

Categories - Disease States, Dysphagia Treatment, Research
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