DeglutitionDisorders

Dysphagia Ben Savage  

 

A 79 year old woman was referred to our ear, nose, and throat outpatient clinic with a history of hoarse voice. This symptom had been present for around three months. It initially fluctuated in severity but eventually became constant. There was no associated pain, weight loss, cough, dysphagia, odynophagia, or other upper airway symptoms. She had not recently had surgery or experienced trauma. Her medical history was of chronic obstructive pulmonary disease, and she was an ex-smoker.  

A 92 year old woman presented to the emergency department after collapsing at home. She recalled standing from her chair, feeling lightheaded, and then collapsing. She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer.  

A 92 year old woman presented to the emergency department after collapsing at home. She recalled standing from her chair, feeling lightheaded, and then collapsing. She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer.  

A 51 year old woman presented with a two day history of odynophagia, followed by two days of vomiting after eating solids and subsequently also after drinking liquids. These symptoms were not accompanied by dysphagia, reflux symptoms, or change in bowel habit. A laparoscopic gastric band insertion eight years earlier had resulted in 10 kg weight loss. However, she had experienced similar symptoms four years ago, and these had resolved after deflation of the gastric band through aspiration from the subcutaneous port. She had no other medical history of note.  

A 51 year old woman presented with a two day history of odynophagia, followed by two days of vomiting after eating solids and subsequently also after drinking liquids. These symptoms were not accompanied by dysphagia, reflux symptoms, or change in bowel habit. A laparoscopic gastric band insertion eight years earlier had resulted in 10 kg weight loss. However, she had experienced similar symptoms four years ago, and these had resolved after deflation of the gastric band through aspiration from the subcutaneous port. She had no other medical history of note.  

Findings may 'change the landscape' of dysphagia interventionNearly 40 percent of Americans 60 and older are living with a swallowing disorder known as dysphagia.  

This slideshow covers history taking and examination, management of dysphagia, with a focus on Oesophageal differentials  

Your patient with respiratory failure was successfully intubated and admitted to the MICU. Two weeks later he comes back to the ED complaining of persistent hoarse voice and dysphagia. He states he was extubated 1 week prior and was told his symptoms would resolve but they hadn’t. What could be going on?  

A 23 year old man presented with a rash eight weeks after emigrating to the United States. One week after immigration he had a sore throat, dysphagia, and mild subjective fevers, which resolved in 10 days. Two weeks later, he developed a papular eruption starting on his hands and feet. He had no arthralgia, myalgia, or systemic symptoms. He took no drugs, had no allergies, no family history of skin eruptions, and no close contacts with a similar rash.  

A 23 year old man presented with a rash eight weeks after emigrating to the United States. One week after immigration he had a sore throat, dysphagia, and mild subjective fevers, which resolved in 10 days. Two weeks later, he developed a papular eruption starting on his hands and feet. He had no arthralgia, myalgia, or systemic symptoms. He took no drugs, had no allergies, no family history of skin eruptions, and no close contacts with a similar rash.  

A 23 year old man presented with a rash eight weeks after emigrating to the United States. One week after immigration he had a sore throat, dysphagia, and mild subjective fevers, which resolved in 10 days. Two weeks later, he developed a papular eruption starting on his hands and feet. He had no arthralgia, myalgia, or systemic symptoms. He took no drugs, had no allergies, no family history of skin eruptions, and no close contacts with a similar rash.  

A 23 year old man presented with a rash eight weeks after emigrating to the United States. One week after immigration he had a sore throat, dysphagia, and mild subjective fevers, which resolved in 10 days. Two weeks later, he developed a papular eruption starting on his hands and feet. He had no arthralgia, myalgia, or systemic symptoms. He took no drugs, had no allergies, no family history of skin eruptions, and no close contacts with a similar rash.  

We reviewed the evidence for management of swallowing difficulties (dysphagia) in people with one of the many hereditary ataxias.