1. 1

2.  Dysphagia :
is difficulty in swallowing which may
affect any part of swallowing pathway
 Odynophagia :
Is sensation of pain during swallowing
2

3.  Congenital :
* Choanal atresia
* Cleft lip & palate
* Laryngomalacia
* Unilateral vocal cord paralysis
* Laryngeal cleft
* Trachiooesophageal fistula
* Vascular rings.
3

4.  Acquired :
1- Traumatic :
- Accidental & iatrogenic
- Blunt trauma , penetrating injuries &
compression effect .
- Direct injury & cranial nerve damage .
- Head injury .
4

5. 2- Infectious :
- Acute pharyngitis , tonsillitis , quinsy .
- Glandular fever
- Acute supraglottitis.
- Herpetic , fungal , cytomegalovirus mucosal
lesion .
- Candidiasis.
- Tuberculosis.
- Submandibular , parapharyngeal & retropharyngeal
abscess 5

6. 3- Inflammatory :
0- Gastroesophageal reflux disease + stricture
formation .
0- Patterson Brown– Kelly or Plummer ‫ ــ‬Vincent
syndrome .
0- Systemic autoimmune disorders :
scleroderma , S.L.E. , dermatomyositis , mixed
connective tissue disease , benign pemphigoid ,
Crohn’s disease .
6

7. 4- Oesophageal motility disorders :
* Achalasia.
* Diffuse oesophageal spasm .
* “ Nutcracker “ oesophagus .
5- Neoplastic :
* Benign & malignant tumours of the oral
cavity , pharynx , oesophagus .
* Nasopharyngeal CA.
* Skull base tumours .
* Leukaemias & lymphomas .
* Enlarged mediastinal lymph nodes . 7

8. 6- Neurological
* C.V.A.
* Isolated recurrent laryngeal nerve palsy
* Parkinson’s disease
* Multiple sclerosis .
* Myasthenia gravis .
* Motor neuron disease .
8

9. 7- Drug induced :
* drugs causing oesophagtis .
* Inhibitory drug side effects .
* Excitatory drug side effects .
* Drug complications .
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10. 10

11. 8- Aging :
* Presbydysphagia .
9- Miscellaneous :
* Foreign body in the pharynx & oesophagus .
* Caustic stricture
* Pharyngeal pouch .
* Globus pharyngeus .
* Patiant with tracheostomy .
* Thyroid disease .
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12. History
Physical Exam
Review of systems
Imaging Studies
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13.  Onset , duration , severity
 Perceived level of Dysphagia
 Type of food
 F.B. sensation in throat / Globus pharyngeus
 Regurgitation (oral or nasal , timing )
 Aspiration
 weight loss
 Pain
 Hoarseness / airway obstruction
 Neck swelling
 Ear ache 13

14. ◙ Onset /duration / course
◙ Perceived level of obstruction
◙ Type of food : more to solid or fluid
- Progressive dysphagia for the solid suggested
structural lesion
- Dysphagia for liquid suggested neurological lesion
- Odynophagia ( painful swallowing ) suggested
spasm , mucosal inflammation, or distention
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15. 15

16. Complete E.N.T. Examination :
- Oropharyngeal
- Laryngeal
- Neck examination
Neurological Examination
Associated physical examination
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17. 17

18. A- Laboratory test :
Hb. , S.iron binding capacity , blood film , ESR , C-reactive protein , liver fun. test ,
B. urea &elect.
B- Radiological :
♪ - Plain X-ray . Widening of prevertebral space , F.B. , vert. osteophyte , radiolucent
area (thyroid CA ) , CX-ray
♪ - Barium swallow .
♪ - Fluoroscopy : with video .
♪ - Endoscopy ( flexible / rigid ) :
- Visualizes interior of pharynx , larynx , esophagus .
- Diagnoses ulcer , tumours
- can take biopsy .
♪ - CT/MRI
- For tumours , extrinsic compression .
C- Manometry : Diagnoses motility disorders .
18

19. a
b
Oral contrast study of
the esophagus shows
pooling of contrast
medium in the
diverticular pouch (*) in
the anteroposterior (a)
and lateral (b)
projections
19

20. Carcinoma
Sternocleidomastoid
muscle
The axial CTscan demonstrates a mass that is completely filling
the right hypopharynx. The arrows point to an ipsilateral
lymph-node metastasis below the sternocleidomastoid muscle.
20

21. 21

22. Esophagoscopy
Esophageal Squamous Cell Carcinoma.
22

23. Medical Treatment
• if possible address underlying cause (e.g., iron
supplementation for Plummer-Vinson,
pyridostigmine for myasthenia gravis, benztropine
for Parkinson’s disease, antibiotics for acute
bacterial pharyngitis)
• utilize an alternative temporary route of nutrition
(nasogastric tube feeds, parenteral nutrition)
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24. Medical Treatment
• begin a reflux regimen (see GERD, below)
• aggressively address aspiration pneumonia
(hold oral feeds, antibiotic regimen, and
aggressive pulmonary toilet)
• Botulinum Toxin Injections: may be
considered for cricopharyngeal spasms,
inject toxin into cricopharyngeus muscle
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25. • change food consistencies (pureed diet
easier to tolerate initially, liquids are more
difficult to manage)
• posture techniques (chin tuck, head turn to
the poorer functioning side), palatal
prostheses, muscle strengthening exercises
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26. • Supraglottic Swallow :
patient voluntarily closes airway at vocal folds by
holding breath before swallow, voluntary cough after
swallow, follow with an additional swallow for
residual bolus in pharynx or pyriform
• Mendelsohn Maneuver :
voluntarily elevates and anteriorly displaces larynx to
prolong upper esophageal sphincter opening
26

27. • Esophageal Dilation :
may be considered for achalasia (distal Lower Eso spasm), and pharyngeal
or esophageal strictures, webs, postoperative scarring, and post
Radiation strictures
• Cricopharyngeal Myotomy :
may be considered for cricopharyngeal spasms (incomplete Upper Eso.
relaxation) or abnormal muscular contraction during relaxation
27
(controversial), theoretically relaxes pharyngoesophageal segment

28. • Gastric or Jejunal Feeding Tube :
temporary or permanent enteric feeding
• Vocal Fold Medialization:
for unilateral vocal fold paralysis
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