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American Family Physician Jan 2021Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive... (Review)
Review
Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.
Topics: Deglutition; Deglutition Disorders; Esophagus; Family Practice; Female; Humans; Male; Pharynx; Physical Examination
PubMed: 33448766
DOI: No ID Found -
The Korean Journal of Gastroenterology... Feb 2021Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia.... (Review)
Review
Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia. In patients with swallowing difficulties, it is important to determine whether the dysphagia is oropharyngeal or esophageal. Patients with orophayngeal dysphagia are likely to develop aspiration and aspiration pneumonia, so accurate diagnosis should be made in the early stages of complaining of swallowing difficulties. Patients with orophayngeal dysphagia complained difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Patients with esophageal dysphagia complained difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck in the esophagus. Esophageal dysphagia should be characterized by analyzing whether foods that cause swallowing difficulties are solid, liquids or both, whether symptoms are progressive or intermittent, how severe, and associated symptoms, such as weight loss, heartburn, or regurgitation. The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history. If esophageal motility disorder is suspected, barium esophagogram is performed first, and upper endoscopy is performed first if structural abnormalities are suspected. If an upper endoscopy shows normal findings, but the esophagus is still suspected of mechanical obstruction, a barium esophagogram is performed. Esophageal manometry should be performed in patients with swallowing difficulties who are suspected of esophageal motility disorder or have normal findings in upper endoscopy.
Topics: Deglutition; Deglutition Disorders; Esophageal Motility Disorders; Humans; Manometry; Pharynx
PubMed: 33632995
DOI: 10.4166/kjg.2021.017 -
International Journal of Environmental... Feb 2022Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during...
Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during the night. The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population. Typical nocturnal symptoms are the persistent snoring and awakenings with dyspnea sensation. On the other hand, diurnal symptoms could be sleepiness, headaches, asthenia, neurological disorders, and impaired personal relationships. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls.
Topics: Humans; Lung; Middle Aged; Pharynx; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring
PubMed: 35206645
DOI: 10.3390/ijerph19042459 -
The British Journal of Radiology Sep 2023The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who... (Review)
Review
The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination in the first instance. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are valuable in certain clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.
Topics: Humans; Pharynx; Cross-Sectional Studies; Deglutition Disorders; Deglutition; Fluoroscopy
PubMed: 37334795
DOI: 10.1259/bjr.20230046 -
Head and Neck Pathology Mar 2022The new WHO classification of head and neck tumors provides a comprehensive overview of lesions by summarizing their clinical, epidemiological, histological,... (Review)
Review
The new WHO classification of head and neck tumors provides a comprehensive overview of lesions by summarizing their clinical, epidemiological, histological, immunohistochemical, molecular and genetic features. The chapters related to the description of oropharyngeal and nasopharyngeal lesions have thus been largely modified.
Topics: Head and Neck Neoplasms; Humans; Nasopharynx; Oropharynx; World Health Organization
PubMed: 35312986
DOI: 10.1007/s12105-022-01449-2 -
Neuromuscular Disorders : NMD Jan 2021Dysphagia (impaired swallowing) is not a rare problem in various neuromuscular disorders, both in the pediatric and the adult patient population. On many occasions such... (Review)
Review
Dysphagia (impaired swallowing) is not a rare problem in various neuromuscular disorders, both in the pediatric and the adult patient population. On many occasions such patients are first presented to other medical specialists or health professionals. Disorders of deglutition are probably underrecognized in patients with a neuromuscular disease as a result of patient's and doctor's delay. This review will focus on dysphagia in adults suffering from a myopathy. Dysphagia in myopathies usually affects the oropharyngeal phases which rely mostly on voluntary muscle activity of the mouth, pharynx and upper esophageal sphincter. Dysphagia is known to contribute to a reduction of quality of life and may also lead to increased morbidity and mortality. The review includes an overview on symptomatology and tools of assessments, and elaborates on dysphagia in specific hereditary and acquired myopathies.
Topics: Deglutition; Deglutition Disorders; Esophagus; Humans; Mouth; Muscular Diseases; Pharynx; Quality of Life
PubMed: 33334661
DOI: 10.1016/j.nmd.2020.11.001 -
European Archives of... Jun 2024To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce... (Review)
Review
PURPOSE
To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce the risk of aspiration without sacrificing vocal function.
METHODS
We searched the PubMed database and used Google Scholar search engine to find studies discussing the different swallowing improvement surgeries. A manual search of references in selected articles and reviews was done as well. No chronologic limitation was set for the studies; however, only articles written in English and Japanese were considered. Due to the nature of this article, no particular inclusion or exclusion criteria were set when searching for studies to be used as references; however, all relevant studies were reviewed and agreed upon by the authors for inclusion in this review article.
RESULTS/DISCUSSION
Surgeries to improve swallowing function can be categorized into those that reinforce nasopharyngeal closure or pharyngeal contraction, improve laryngeal elevation or pharyngoesophageal segment opening, and those that improve vocal fold closure to protect the airway during swallowing. They are an effective alternative treatment that may significantly improve these patients' quality of life. Swallowing rehabilitation with the altered pharyngolaryngeal structures is required post-operatively to significantly improve patients' dysphagia.
CONCLUSIONS
Surgeries to improve swallowing function address specific dysfunctional sites involved in the swallowing mechanism. Choosing the most appropriate surgery for each patient requires knowledge of the pathophysiology for their dysphagia and detailed pre-operative work-up.
Topics: Humans; Deglutition; Deglutition Disorders; Larynx; Otorhinolaryngologic Surgical Procedures; Pharynx
PubMed: 38265461
DOI: 10.1007/s00405-024-08452-z -
CMAJ : Canadian Medical Association... Jul 2021
Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pharynx; Polymerase Chain Reaction
PubMed: 34312175
DOI: 10.1503/cmaj.202183-f -
Indian Pediatrics Apr 2023
Topics: Female; Humans; Hypertrichosis; Pharynx; Cervix Uteri
PubMed: 37002853
DOI: No ID Found -
HNO May 2021In 2021, the German Society of Otorhinolaryngology, Head and Neck Surgery is celebrating the 100th anniversary of its foundation. The aim of this article is to present... (Review)
Review
In 2021, the German Society of Otorhinolaryngology, Head and Neck Surgery is celebrating the 100th anniversary of its foundation. The aim of this article is to present the main inventions and progress made in Germany before 1921, the date the society was founded. Three chronological periods are discernible: the history of otorhinolaryngology (ORL) in Germany until the beginning of the 19th century, focusing mainly on the development of scattered knowledge; the birth of the sub-specialties otology, laryngology (pharyngo-laryngology and endoscopy), and rhinology in the 19th century, combining advances in knowledge and implementation of academic structures; and the creation of the ORL specialty at the turn of the 20th century, mainly concentrating on academic organization and expansion. This period was crucial and allowed for the foundation of the German Society of Otorhinolaryngology, Head and Neck Surgery on solid ground. Germany played an important role in the development and progress of ORL internationally in the 19th century with such great contributors as Anton von Tröltsch, Hermann Schwartze, Otto Körner, Rudolf Voltolini, and Gustav Killian to mention a few.
Topics: Endoscopy; Germany; History, 19th Century; History, 20th Century; Medicine; Otolaryngology; Pharynx
PubMed: 33847769
DOI: 10.1007/s00106-021-01046-9