Oropharyngeal Dysphagia

What is oropharyngeal dysphagia?

Oropharyngeal dysphagia is at term that describes swallowing problems occurring in the mouth and/or the throat. These swallowing problems most commonly result from impaired muscle function, sensory changes, or growths and obstructions in the mouth or throat.

What causes oropharyngeal dysphagia?

Oropharyngeal dysphagia can have many causes. Some causes may include:

• Individuals with neurological problems, such as stroke, head injury, or Parkinson’s disease
• Cancer of the mouth or throat
• Surgery and/or radiation to treat head and neck cancer
  • Some surgeries may unintentionally and occasionally result in swallowing problems (for example, anterior cervical spine fusion surgery, carotid artery surgery, heart surgery, etc)
• Bony changes to the cervical spine (the part of the spine that supports the neck) such as cervical osteophytes

Oropharyngeal dysphagia can commonly result from muscle weakness. Additionally, a person may have reduced ability to feel food, liquid or saliva that remains in the mouth or throat after swallowing. In some cases, an individual may not be able to feel food, liquid or saliva entering the windpipe (called aspiration). Some individuals have problems such as scar tissue or muscle spasm of cricopharyngeus muscle (at the transition between the throat and esophagus) or an abnormal pocket into which food, liquid or saliva can collect (called a diverticulum), that can get in the way of the swallowed material moving through throat and upper esophagus and on to the stomach.  

What are the symptoms of oropharyngeal dysphagia?

The most common symptoms of oropharyngeal dysphagia are:

• Difficulty swallowing
• Coughing associated with swallowing food, liquid and/or saliva
• Feeling food sticking in your throat

Who assesses oropharyngeal swallowing problems?

Laryngologists and speech pathologists, within the UCLA Swallowing Disorders Program, work closely together to assess and treat oropharyngeal swallowing disorders.

How is oropharyngeal dysphagia diagnosed?

The most commonly used instrumental exams of the oropharyngeal swallow are:

1. Modified barium swallow study (MBSS). This is an X-ray test usually performed by a speech pathologist with radiology personnel.
   1. The individual sits in a chair and drinks liquid and eats food
   2. Everything swallowed has barium mixed in
   3. Barium is used because it shows up on X-rays
   4. The speech pathologist examines how an individual swallows.
2. Fiberoptic endoscopic evaluation of swallowing (FEES) / transnasal esophagoscopy (TNE). This is an endoscopic examination.
   1. A small scope is placed into a person’s nose
   2. The scope is advanced into upper part of the throat
   3. A doctor (usually a head and neck surgeon) or a speech pathologist watches as a person swallows liquid and food

What are treatment options for oropharyngeal dysphagia?

Surgical and behavioral treatment approaches exist to treat oropharyngeal swallowing problems. The treatment recommended will depend on an individual’s particular swallowing problem and what is causing it. We will review your dysphagia history, physical exam, and swallow studies to recommend the optimal management plan. In general, surgery is recommended to treat tissue in the throat or upper esophagus that obstructs the movement of food, liquid and/or saliva through the throat on its way to the stomach. Swallow therapy is a behavioral treatment to strengthen swallow muscles and reduce material going into the windpipe.

Watch a video on transnasal esophagoscopy (TNE) in dysphagia evaluation and management