You’re having a hard time getting the
bolus from the mouth into the pharynx.
Think of Amyotrophic Lateral
Sclerosis; you take a cotton swab,
go to the back of the neck, but you
don’t have a gag reflex, right?
Neural issues; ALS,
My topic, oro-pharygeal
dysphagia, that clear?
You literally can’t even get the food
or bolus from mouth into the esophagus.
This is where you are, in this region.
Symptoms are coughing, regurgitation and choking
because you can’t get it into your esophagus.
Look for the patient
keeping the food here.
Because they can’t get
it into the esophagus.
They’re not trying to be annoying.
They just can’t.
Now, because you can’t get it into the esophagus,
often times you may get it into the wrong tube.
Instead of getting it into the posterior esophagus, you
get into the anterior trachea and if you get it in
there often enough, your patient often times with ALS or
nerve damage, they will suffer from aspiration pneumonia.
Video-fluoroscopy can show
the structural lesion.
Work-up for CNS lesions; stroke,
multiple sclerosis, Lou Gehrig,
Parkinson, myasthenia gravis - all wonderful differentials
that you want to keep in mind if you’re thinking about a patient
who’s not able to get food from the mouth into the pharynx.