OVERVIEW

What is oropharyngeal dysphagia?

Strictly speaking, dysphagia is not a disease but rather a symptom, which is one of the clinical manifestations of certain conditions. Dysphagia is easy to understand—it refers to an obstruction in the entire process of food moving from the mouth to the stomach, often causing patients to feel as if food is stuck in the "throat," choking, or even experiencing pain behind the sternum. Food passes through three parts from the mouth to the stomach: the mouth (oral cavity), the throat (pharynx), and the esophagus. Oropharyngeal dysphagia specifically refers to obstructions occurring in the mouth and throat. Damage to nerves or muscles involved in swallowing, disorders of the swallowing center, or compression of the oropharyngeal region can all lead to oropharyngeal dysphagia. It can be diagnosed based on medical history and clinical manifestations. Once the underlying condition is treated, the symptoms of oropharyngeal dysphagia typically resolve. However, if the underlying condition cannot be cured, the dysphagia may persist.

What are the types of oropharyngeal dysphagia?

• Based on etiology, dysphagia can be classified as mechanical or functional (motility-related);

• Based on the location of the obstruction, it can be categorized as oropharyngeal or esophageal.

Is oropharyngeal dysphagia common in clinical practice?

Oropharyngeal dysphagia primarily affects the elderly, with a prevalence of 14%–33% among residents aged 65 and older. The rate is even higher in hospital settings, and approximately 70% of nursing home residents exhibit signs of dysphagia.

SYMPTOMS

What are the manifestations of oropharyngeal dysphagia?

Oropharyngeal dysphagia manifests as difficulty when food is being prepared to be swallowed in the mouth or throat. Patients often experience an inability to swallow, food getting stuck in the "throat," a choking sensation, coughing or drooling while swallowing, food reflux, and in severe cases, may even lead to malnutrition and dehydration.

CAUSES

How does oropharyngeal dysphagia occur?

There are many diseases that can cause oropharyngeal dysphagia, such as nerve damage related to swallowing caused by trauma, swallowing center issues due to cerebrovascular disease, neurodegenerative diseases like Parkinson's or amyotrophic lateral sclerosis, neuromuscular disorders like myasthenia gravis or muscular dystrophy, or local structural lesions in the oropharynx such as tumors or thyroid enlargement causing compression.

Is oropharyngeal dysphagia hereditary?

This depends on the underlying cause. If the condition is caused by a hereditary disease (e.g., oculopharyngeal muscular dystrophy), it may be inherited. Otherwise, it is not.

Is oropharyngeal dysphagia contagious?

Generally, no.

DIAGNOSIS

How is oropharyngeal dysphagia diagnosed?

It can be determined based on clinical manifestations and medical history. However, the most important aspect of the diagnostic process is identifying the underlying cause.

What tests are needed for diagnosing oropharyngeal dysphagia?

First, it is essential to clarify that the purpose of testing is to identify the cause:

• Physical examination: The first step is to rule out local structural abnormalities, so a detailed physical examination of the oral cavity and head/neck region is necessary to check for swelling, masses, etc. A thorough neurological examination should also be performed, with particular attention to nerves related to swallowing (trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal nerves).

• Laryngoscopy: A specialized scope is used to examine the oropharynx, larynx, and upper esophagus for structural abnormalities. This procedure may cause slight discomfort but is not traumatic.

• Electromyography (EMG): Electrodes are placed on the muscles, or needle electrodes may be used to assess muscle function. Needle electrodes may cause a pricking sensation, similar to an injection.

• Other tests: If the physician suspects a specific condition based on medical history and symptoms, additional tests may be ordered. For example, a CT or MRI may be performed if a cerebrovascular disease is suspected, or a neostigmine test may be conducted for suspected myasthenia gravis.

What conditions can oropharyngeal dysphagia be confused with?

Oropharyngeal dysphagia should be differentiated from esophageal dysphagia.

The key difference is that oropharyngeal dysphagia causes difficulty at the very start of swallowing, whereas esophageal dysphagia leads to a sensation of obstruction a few seconds after swallowing.

TREATMENT

Which department should I visit for oropharyngeal dysphagia?

Gastroenterology.

Is it necessary to seek medical treatment for oropharyngeal dysphagia?

Yes.

How is oropharyngeal dysphagia treated?

Treatment depends on the underlying cause. Patients with mild symptoms may require rehabilitation exercises, while those with severe symptoms may need nasogastric tube feeding for enteral nutrition.

• Surgical treatment: For patients with structural abnormalities, such as oropharyngeal tumors or thyroid enlargement causing compression, surgical removal may be an option. For oropharyngeal dysphagia caused by cricopharyngeal muscle dysfunction, a cricopharyngeal myotomy may be performed.

• Botulinum toxin therapy: For cricopharyngeal muscle dysfunction, if the patient is not suitable for surgery or concerned about surgical risks, botulinum toxin injections can relax the muscle and improve swallowing.

• Neuromuscular electrical stimulation therapy: Electrical stimulation may slightly improve muscle strength and can be used for oropharyngeal dysphagia caused by neurodegenerative diseases such as Parkinson's disease or muscular dystrophy. However, high-quality clinical trials to support this treatment are lacking.

Can oropharyngeal dysphagia be cured?

If the underlying cause is identified and the primary disease can be cured, oropharyngeal dysphagia may also be cured.

DIET & LIFESTYLE

What dietary precautions should be taken for oropharyngeal dysphagia?

Replace food with thicker, cohesive liquid foods. Eat small amounts frequently, with each bite being smaller in quantity.

What lifestyle precautions should patients with oropharyngeal dysphagia take?

Closely monitor the patient while eating. If choking or coughing occurs, handle it immediately or seek medical attention as soon as possible.

Does oropharyngeal dysphagia affect fertility?

No.

Can individuals with oropharyngeal dysphagia fly, engage in strenuous exercise, or travel to high-altitude areas?

Yes.

PREVENTION

Can oropharyngeal dysphagia be prevented?

It generally cannot be prevented.