Dysphagia

A dysphagia or swallowing disorder occurs when one of the structures involved in the act of swallowing is impaired in their function and their interaction. Thus, all diseases and conditions of the oral cavity and their limitations, the pharynx, the esophagus and the stomach entrance, next to, above all, neurological problems and mental disorders play a causal role. Dysphagia may be associated with or without pain. The painful swallowing is also called odynophagia.

Since swallowing disorders have a significant effect of physical, mental and social well-being by themselves, they always require clarification.

Symptoms

Possible symptoms of dysphagia are

• A pressure or feeling of a lump in the throat
• Gag reflex during act of swallowing;
• A regurgitation of already the ingestion food (especially in Ösophagusdivertikeln ( bulges of the esophagus ) )
• Cough during the meal as an expression of penetration ( penetration of food / liquids into the upper respiratory tract before swallowing ) or aspiration ( the crossing of food / liquids into the lower respiratory tract )
• Hypersalivation
• In extreme cases, a general inability to food intake

Accompanying symptoms may include nasal speech ( especially when swallowing paralysis ) and hoarseness occur

Sequelae can be acute and recurrent pneumonia and fever.

Frequency

45 per cent of over 75s suffer from dysphagia, which are mutually negatively affect neurological, psychiatric and general chronic diseases due to the often existing at the age multimorbidity in general.

It should be emphasized that not all patients with a swallowing disorder are also aware of this. Especially in multiple sclerosis and ALS only aspiration pneumonia leads to clarification.

Causes

There are many reasons for a swallowing disorder, a psychological cause may be more likely accepted, the younger the patient and the changing nature of symptoms. While the patient's appearance can already give indications of a mental genesis of the problems, but in principle, any swallowing disorder carefully clarified.

Physical causes

Injuries and tumors of the oral cavity, pharynx and esophagus, disruption of motor innervation of the muscles involved in the swallowing process

Oral cavity and pharynx

• Dehydration with dehydration of the oral mucosa.
• Inflammation caused by infections caused by viruses, bacteria, fungi, autoimmune processes, chemical irritant, due to radiation exposure, exposure to heat,
• Tonsillitis or pharyngitis, which also occur with a common cold and other infections with this potential, the muscles concerned functional disorders.
• Abscesses as Retrotonsillarabszess
• Malfunction of the tongue and mouth floor muscles
• Malfunctions in dental or orthodontic problems: Malocclusion,
• Poorly fitting dentures

Esophagus

• Achalasia
• Esophageal
• Esophagitis
• Esophageal carcinoma
• Esophageal stenosis

Thyroid

• Thyroiditis
• Struma

Neurological Disorders

• Myasthenia gravis
• Multiple sclerosis
• Parkinson's disease
• Amyotrophic Lateral Sclerosis
• Dementia
• Stroke
• Craniocerebral trauma
• Chorea major, chorea
• Other neurodegenerative diseases

Psychological Causes

The undisturbed swallowing process allows the life-sustaining fluid and food intake, but also the experience of pleasure and well -being. Thus, a disturbance of swallowing is point may even on disorders of psychological well-being - after physical causes were excluded.

Diagnostics

• Observation act of swallowing ( mobility of the larynx / Adam's apple )
• Review of the gag reflex, tongue function and all other muscles involved in swallowing by Phoniater, neurologists and / or speech therapist, speech therapy educators, clinical linguists, occupational therapists

A clinical examination of swallowing function also contains the following parameters:

• Clinical anamnesis ( medical records, interview with patients and their families )
• Descriptive observations ( body posture, facial expressions, breathing)
• Review of orofacial motility and sensitivity ( both outside and in the oral cavity )
• Mouth Inspection ( arthroplasties, mucous membranes, atrophy, pads, etc.)
• Checking the reflexes ( Palatalreflex, gag reflex, cough reflex, swallowing reflex )
• FEES ( fiberendoscopic evaluation of swallowing ) - Review of the food ( mushy, liquid, solid and crumbly ) by means of a flexible endoscopy of the nose
• Gastroscopy
• X-ray examination: Ösophagusbreischluck ( Videokinematographie act of swallowing ) for functional assessment
• Videofluoroscopy for functional time-critical assessment of different consistencies ( mushy, liquid, solid, crumbly )
• Still experimental: high-speed MRI
• X-ray of the cervical spine

Complications

Each act of swallowing involves the likelihood to participate in food and liquid (also on own saliva ) to " swallow ", and this ultimately leads to aspirate into deeper lung shares. Accordingly, aspiration pneumonia can develop, which is responsible for example for 20 % of deaths in the first year of diagnosis in stroke patients.

Since the age and the taste and sense of smell are impaired and the appetite is gone missing from mostly unknown reasons, even a slight dysphagia may ultimately lead to the complete refusal of food with all the consequences such as weight loss, dehydration and further reduction of the general condition.

Therapy

The treatment depends on the results of physical or psychosomatic studies. A nasogastric tube or a PEG ( percutaneous endoscopic gastrostomy with probe ) may be indicated when oral nutrition is not possible and the patient must be fed through a nasogastric tube.

There are ( präoral, oral, pharyngeal and esophageal ) in each phase of swallowing therapeutic intervention by the speech and swallowing therapy. Objectives are first to restore the intraoral sensitivity and the construction of protective reflexes ( gag reflex, cough reflex, swallowing reflex ). The spectrum ranges from motor exercises of individual muscle groups, massage, thermal stimulation on changes in posture while eating (eg by changing the head position ) to changes in the food consistencies (eg pureeing of food or thicken liquids). Evidence-based are the so-called swallowing maneuvers (eg, Mendelsohn maneuver, supraglottic or swallowing), which allow for improved airway protection during swallowing and thus can prevent aspiration of food.

Etymology

Dysphagia is derived from the Ancient Greek prefix δυς ( which means something Unhappy or retardant, according to the German prefix, miss- 'or' un - ') and the verb φαγεῖν phagein, eat ' from. Literally, therefore, means a disorder dysphagia when eating. In odynophagia, the first word element leaves on ὀδύνη Odyne, pain ' lead back.