Swallowing Disorders and Cricopharyngeal Dysfunction

A functional swallow involves the neuromuscular coordination of ingestion and digestion of food. Dysphagia is the term for abnormal swallowing, a discoordination of respiration, phonation, and digestion. Swallowing disorders can describe a simple abnormal sensation of swallow or a complex disorder leading to aspiration pneumonia. The most common cause of mortality and morbidity in dysphagia patients is aspiration pneumonia. Additional complications include malnutrition and dehydration. The prevalence of oropharyngeal dysphagia is up to 40% in adults over 65 and increases to 60% in institutionalized elderly. Oropharyngeal dysphagia is common after stroke, Parkinson’s disease, and other neurologic disorders. Patients in high-risk groups and patients with signs and symptoms of dysphagia should be diagnosed appropriately to determine underlying cause and aspiration risk. This chapter will focus on dysphagia due to pharyngeal phase disorders and their diagnosis and treatments. This review contains 6 figures, 4 videos, 5 tables and 49 references. Key Words: dysphagia, swallowing, Zenker diverticulum, modified barium swallow, videofluoroscopic swallowing study, FEES, transnasal esophagoscopy, esophagram

Evaluation of Oropharyngeal pH-Monitoring in the Assessment of Laryngopharyngeal Reflux

Background: Laryngopharyngeal reflux (LPR) is a prevalent disorder. The aim of the present retrospective cohort study was to evaluate oropharyngeal pH-monitoring using a novel scoring system for LPR. Methods: In a total of 180 consecutive patients with possible LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring and transnasal esophagoscopy were carried out for further investigation. Results: In our series, 99 (55%) patients had severe LPR, 29 (16%) cases presented with moderate and 23 (13%) with mild severity, 9 (5%) subjects revealed neutral values, and 7 (4%) individuals were alkaline, while 13 (7%) patients had no LPR. In detecting LPR, the sensitivity, specificity and accuracy of oropharyngeal pH-monitoring was 95%, 93% and 94%, respectively. Conclusion: Oropharyngeal pH-monitoring is a reliable tool in the assessment of LPR, but the pH graphs have to be precisely analyzed and interpreted in context with other validated diagnostic tests.

Transnasal Esophagoscopy Examination in Outpatient Unit, Department of Otorhinolaryngology Head and Neck Surgery, Dr. Soetomo Hospital, Surabaya

Esophagoscopy is the standard examination standard for evaluation, diagnosis, screening and surveillance of esophageal diseases. Although it is often done, esophagoscopy costs a lot, is inconvenient, and risks complications, including cardiopulmonary complications because patients usually require routine sedation in the implementation of conventional esophagoscopic procedures. The purpose of this study is to get an overview of the results of the implementation of transnasal esophagoscopy in Department of Otorhinolaryngology Head and Neck Surgery, Division of Broncho-oesophagology, Dr. Soetomo Hospital, Surabaya, between 1 September 2012 and 30 April 2015. This study was a retrospective descriptive study with a population of all patients undergoing esophagoscopic examinations during this period. Data is taken from medical records of new patients undergoing transnasal esophagoscopy. Inclusion criteria were all patients who had been tested for transnasal esophagoscopy, and exclusion criteria were incomplete medical record data. There were 35 patients who underwent transnasal esophagoscopy examination at Department of Otorhinolaryngology Head and Neck Surgery, Division of Broncho-oesophagology, Dr. Soetomo Hospital, Surabayaduring the study period. The mean of patients who participated in the study was 54.17 ± 14.02. 23 male patients (63.89%), while 12 female patients or 34.11%. Indications of dysfagi are found in all age groups, most in the age group 51-70 years. Metastases in head and neck malignancies are found in the age group 31 - 50 years and 51 - 70 years. Indications for heartburn are found in the age group 21-50 years and 51-70 years. In conclusion, the results of transnasal esophagoscopic examination showed that most patients had a normal picture (60%) and a positive picture with an esophageal abnormality of 40%. The most common features are lesions in the mucosal esophagus lumen, scar, masses and stenosis.

Transnasal Esophagoscopy Examination in Outpatient Unit, Department of Otorhinolaryngology Head and Neck Surgery, Dr. Soetomo Hospital, Surabaya

Esophagoscopy is the standard examination standard for evaluation, diagnosis, screening and surveillance of esophageal diseases. Although it is often done, esophagoscopy costs a lot, is inconvenient, and risks complications, including cardiopulmonary complications because patients usually require routine sedation in the implementation of conventional esophagoscopic procedures. The purpose of this study is to get an overview of the results of the implementation of transnasal esophagoscopy in Department of Otorhinolaryngology Head and Neck Surgery, Division of Broncho-oesophagology, Dr. Soetomo Hospital, Surabaya, between 1 September 2012 and 30 April 2015. This study was a retrospective descriptive study with a population of all patients undergoing esophagoscopic examinations during this period. Data is taken from medical records of new patients undergoing transnasal esophagoscopy. Inclusion criteria were all patients who had been tested for transnasal esophagoscopy, and exclusion criteria were incomplete medical record data. There were 35 patients who underwent transnasal esophagoscopy examination at Department of Otorhinolaryngology Head and Neck Surgery, Division of Broncho-oesophagology, Dr. Soetomo Hospital, Surabaya during the study period. The mean of patients who participated in the study was 54.17 ± 14.02. 23 male patients (63.89%), while 12 female patients or 34.11%. Indications of dysfagi are found in all age groups, most in the age group 51-70 years. Metastases in head and neck malignancies are found in the age group 31 - 50 years and 51 - 70 years. Indications for heartburn are found in the age group 21-50 years and 51-70 years. In conclusion, the results of transnasal esophagoscopic examination showed that most patients had a normal picture (60%) and a positive picture with an esophageal abnormality of 40%. The most common features are lesions in the mucosal esophagus lumen, scar, masses and stenosis.

Transnasal Esophageal Stricture Dilatation using Savary–Gilliard Dilator System—A Novel Approach

Transnasal esophagoscopy is office-based procedure, used by otolarynologists and gastroenterologists for evaluation of dysphagia, odynophagia, esophageal stricture dilatations, and other numerous indications. Through the scope (TTS) balloon dilatation using ultrathin gastroscope is routine practice in patients with esophageal stricture (ES). Here, we are highlighting a case of post corrosive esophageal stricture with inadequate mouth opening dilated using savary gilliard (SG) dilator system transnasally.