From the Guidelines
Oropharyngeal dysphagia should be managed with a multidisciplinary approach, including swallowing therapy exercises, dietary modifications, and postural techniques, as recommended by the most recent and highest quality study 1. The diagnosis of oropharyngeal dysphagia involves a comprehensive assessment, including a valid screening tool administered by an expert in dysphagia, such as a speech-language pathologist (SLP) 1. Key aspects of management include:
- Swallowing therapy exercises, such as the Mendelsohn maneuver, effortful swallow, and Shaker exercise
- Dietary modifications, including thickened liquids and soft foods, as recommended by the ESPEN guideline 1
- Postural techniques, such as chin tuck, head turn, and backward head tilt, to reduce aspiration and choking 1 In severe cases, alternative feeding methods like nasogastric tubes or percutaneous endoscopic gastrostomy (PEG) may be necessary. Early intervention is crucial to prevent complications such as aspiration pneumonia, malnutrition, and dehydration, which can significantly impact morbidity, mortality, and quality of life. The condition often results from neurological disorders (stroke, Parkinson's disease), structural abnormalities, or age-related changes in swallowing physiology, so addressing these underlying causes is essential for effective management, as highlighted in the ESPEN guideline 1. It is also important to note that the risk of aspiration can be reduced by increasing liquid viscosity, but thickened liquids may increase the risk of post-swallow oral and pharyngeal residues, as stated in the ESPEN guideline 1. Overall, a comprehensive and multidisciplinary approach to managing oropharyngeal dysphagia is essential to improve outcomes and reduce the risk of complications, as recommended by the most recent and highest quality study 1.
From the Research
Diagnosis of Oropharyngeal Dysphagia
- Dysphagia is a common clinical condition characterized by difficulty in swallowing, and oropharyngeal dysphagia refers to problems in the mouth and pharynx 2
- Early screening and assessment of videofluoroscopic swallowing are recommended for assessing the presence of dysphagia 2
- Fiberoptic endoscopic evaluation of swallowing is also utilized for diagnosis and to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids 3
- Videoendoscopic swallowing studies enable the ENT specialist/phoniatrician to decide on further diagnostic steps, to establish a therapy and to recommend the type of feeding (oral, non-oral) 4
Treatment of Oropharyngeal Dysphagia
- Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, are effective in improving swallowing function and quality of life in patients with dysphagia 2
- Nutritional intervention and an oral care program are also recommended 2
- Swallowing training and nutritional interventions are common approaches to treating oropharyngeal dysphagia 3
- Behavioral treatment programs and techniques, such as compensatory strategies and swallowing exercises, have been developed to facilitate or compensate for specific swallowing disorders 5
- Interdisciplinary management is necessary in many cases due to the etiologic diversity of oropharyngeal dysphagia 4