What type of dysphagia is caused by pharynx infections?

Pharyngeal Infections Cause Oropharyngeal Dysphagia

Pharyngeal infections primarily cause oropharyngeal dysphagia, characterized by difficulty initiating swallowing and transferring food from the mouth to the esophagus. 1, 2

Understanding Oropharyngeal Dysphagia

Oropharyngeal dysphagia occurs when there are problems with:

• Forming a cohesive bolus
• Transferring food from the mouth into the pharynx
• Initiating the involuntary swallowing process 2

Patients with oropharyngeal dysphagia typically present with:

• Food sticking in the throat
• Globus sensation (feeling of a lump in the throat)
• Coughing or choking during swallowing
• Nasal-quality voice or nasal regurgitation
• Food dribbling from the mouth
• Difficulty initiating swallow 1

Pathophysiology of Infection-Related Dysphagia

When pharyngeal infections occur, they can cause:

1. Inflammation of pharyngeal muscles
2. Pain during swallowing (odynophagia) which often accompanies dysphagia
3. Impaired contraction of pharyngeal muscles
4. Reduced hyolaryngeal excursion 3

Diagnostic Approach

For patients with suspected pharyngeal infection causing dysphagia, the American College of Radiology recommends:

• Videofluoroscopic Swallowing Study (VFSS): Gold standard for evaluating swallowing dynamics 4
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES): To visualize pharyngeal and laryngeal anatomy during swallowing 4
• Biphasic Esophagram: Initial diagnostic test for unexplained dysphagia, allowing comprehensive evaluation of both the pharynx and esophagus 1, 4

Screening tools that can be helpful include:

• EAT-10 questionnaire (sensitivity 86%, specificity 76%)
• Volume-Viscosity Test (V-VST) (sensitivity 92%, specificity 80%) 4

Clinical Implications and Management

Management of pharyngeal infection-induced dysphagia should focus on:

1. Treating the underlying infection:

   • Appropriate antimicrobial therapy based on the causative organism
   • Antifungal agents for candidiasis
   • Antiviral agents for viral infections 5

2. Addressing swallowing difficulties:

   • Postural changes (chin down or head turn) to improve airway protection
   • Dietary modifications using the International Dysphagia Diet Standardisation Initiative (IDDSI) framework
   • Thickened liquids for patients with aspiration risk 4

3. Multidisciplinary care:

   • Speech-Language Pathologist (SLP) for swallowing therapy
   • Dietician for nutritional management
   • Physician for medical management of infection 4

Important Considerations and Pitfalls

• Silent aspiration: Up to 55% of patients who aspirate may not exhibit protective cough reflexes, increasing pneumonia risk 4
• Dehydration risk: When using thickened liquids, monitor hydration status carefully 4
• Residual symptoms: Dysphagia may persist even after the infection resolves due to muscle weakness or scarring 3
• Referred symptoms: Abnormalities of the mid or distal esophagus may cause referred dysphagia to the upper chest or pharynx 1

Remember that pharyngeal infections represent a treatable cause of oropharyngeal dysphagia, and prompt identification and management can significantly improve outcomes and prevent complications like aspiration pneumonia.