A dysphagia or swallowing disorder occurs when one of the swallowing structures involved and their interaction is impaired in their function. Thus, all diseases and ailments in the area of the oral cavity and its limitations, the throat , the esophagus and the stomach entrance , in addition, especially neurological problems and mental disorders can play a causal role. The dysphagia can be associated with or without pain. The painful act of swallowing is also known as odynophagia .
Since swallowing disorders result in considerable impairment of physical, psychological and social well-being, they always require clarification.
Possible symptoms of a swallowing disorder are
- a feeling of pressure or lump in the throat
- Gag reflex during the act of swallowing,
- a regurgitation of food already geschluckter (v. a. at Ösophagusdivertikeln (bulges of the esophagus)),
- Coughing during the meal as an expression of penetration (entry of food or liquids into the upper respiratory tract before swallowing) or aspiration (the entry of food or liquids into the lower airways),
- Hypersalivation ,
- in extreme cases, a general inability to eat.
The consequences can be acute and recurring pneumonia and fever.
45% of the over 75 year olds suffer from swallowing difficulties, whereby neurological, psychiatric and general chronic illnesses usually influence each other negatively due to the multimorbidity often existing in old age .
There are various reasons for a swallowing disorder, whereby a psychological cause can be assumed more easily the younger the patient is and the more varied the symptoms are. The appearance of the patient can give indications of a psychological genesis of the problem, but in principle every swallowing disorder must be carefully clarified.
Oral cavity and throat
- Hyposalivation with dehydration of the oral mucous membranes .
- Inflammation caused by infections by viruses, bacteria, fungi, autoimmune processes, chemical-irritative, radiation exposure, exposure to heat,
- Tonsillitis or pharyngitis , which also occur with a cold , as well as other infections with the possible functional disorders affecting the muscles .
- Abscesses such as retrotonsillar abscess
- Malfunction of the tongue and floor of the mouth muscles
- Malfunctions with dental or orthodontic problems:
- Esophageal diverticulum
- Esophageal carcinoma
- Esophageal stenosis
- Schatzki rings
In specialist circles ( nutritional medicine , rehabilitation medicine ) one speaks of the step concept of neurogenic oropharyngeal dysphagia (NOD) with four degrees of severity. The graduation increases from NOD grade 0 (= no dysphagia, i.e. normal food) to NOD grade 1 (= slight dysphagia) and NOD grade 2 (= moderate dysphagia with thickened liquids and passed food) to NOD grade 4 (= massive dysphagia with 100% intravenous tube feeding ).
- Myasthenia gravis
- multiple sclerosis
- Parkinson's disease
- Amyotrophic Lateral Sclerosis
- traumatic brain injury
- Chorea major , minor chorea
- other neurodegenerative diseases
The undisturbed swallowing process enables life-sustaining fluid and food intake, but also the experience of pleasure and well-being. Thus, a disturbance of the act of swallowing can itself indicate disturbances of the psychological well- being - after physical causes have been excluded.
- See also: globe syndrome .
- Observation of the act of swallowing (mobility of the larynx or Adam's apple )
- Review of the gag reflex , tongue function and all the other muscles involved in swallowing by Phoniater , neurologist and / or speech therapy , speech therapy educators , clinical linguistics , occupational therapists
- Assessment of the severity of the swallowing disorder by means of clinical screening (e.g. "Daniels test" [Daniels et al., 1998]). Clinical signs allow a prediction of the severity of dysphagia and the risk of aspiration:
- abnormal voluntary cough
- abnormal gag reflex
- Cough after drinking predetermined amounts of water
- Change in the tone of your voice after a drink of water.
A clinical examination of the swallowing function also includes the following parameters:
- clinical anamnesis (medical record, interview with affected persons and relatives)
- descriptive observations (posture, facial expressions, breathing)
- Check of orofacial mobility and sensitivity (both outside and inside the mouth)
- Oral inspection (prosthesis fitting, mucous membranes, atrophies, plaque, etc.)
- Examination of the reflexes (palatal reflex, gag reflex, cough reflex, swallow reflex)
- FEES (fiberendoscopic evaluation of swallowing) - checking of food intake (pulpy, liquid, solid and crumbly) by means of a flexible endoscopy via the nose
- X-ray examination :
- Gastroscopy examination
- Neurological examination
- Examination of the thyroid
- internal examination
- Dental or orthodontic evaluation
- phoniatric examination
- ENT medical examination
- psychosomatic evaluation - if no physical cause could be found or this does not fully explain the symptoms.
Every act of swallowing carries the risk of "swallowing" food and fluid (including one's own saliva) and ultimately aspirating them into deeper parts of the lungs . As a result, aspiration pneumonia can develop, which in stroke patients z. B. is responsible for 20% of deaths in the first year of illness.
Since the sense of taste and smell are impaired in old age and the appetite has been lost for mostly unknown reasons, a slight swallowing disorder can ultimately lead to complete refusal of food with all subsequent problems such as weight loss, desiccosis and a further reduction in general condition.
Treatment is based on the results of the physical or psychosomatic examinations. A nasogastric tube or a PEG (tube with percutaneous endoscopic gastrostomy) may be indicated if oral feeding is not possible and the patient needs to be fed by gastric tube.
In every swallowing phase (pre-oral, oral, pharyngeal and esophageal) there are therapeutic intervention options through speech and swallowing therapy. Goals are initially restoring the intraoral sensitivity and the structure of the protective reflexes ( gag , cough reflex , swallowing reflex ). The spectrum ranges from motor exercises for individual muscle groups, massages, thermal stimulation, changes in posture while eating (e.g. by changing the position of the head) to changes in food consistency (e.g. pureeing the food or thickening liquids). The so-called swallowing maneuvers (e.g. Mendelsohn maneuvers or supraglottic swallowing), which enable improved protection of the respiratory tract when swallowing and can thus prevent food being aspirated, are evidence-based.
Dysphagia is derived from the ancient Greek prefix δυς- (which denotes something unfortunate or adverse, corresponding to the prefix 'miss-' or 'un-' in German ) and the verb φαγεῖν phagein 'essen'. Literally, dysphagia means a disorder in eating . In odynophagia, the first word component can be traced back to ὀδύνη odýnē 'pain'.
- due to Revising mom. offline (as of 01/2017): S1 guidelines for neurogenic dysphagia of the German Society for Neurology (DGN). In: AWMF online (as of September 30, 2012)
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