Immediate Management of Dysphagia with Sensation of Swollen Throat
While awaiting the scheduled procedure, your priority is to ensure airway safety and rule out esophageal perforation or other acute complications that could be life-threatening.
Urgent Assessment for Perforation
If the patient develops persistent chest pain, breathlessness, fever, or tachycardia, suspect esophageal perforation and obtain an immediate CT scan with oral contrast 1, 2. This is critical because:
- Severe chest pain combined with neck crepitus (subcutaneous emphysema) is pathognomonic for perforation 2
- CT with oral contrast is the gold standard and superior to conventional contrast studies, as it can detect small perforations that water-soluble contrast studies may miss 2
- Chest X-ray alone is insufficient—normal appearances do not exclude perforation 1, 2
Immediate Safety Measures
Provide the patient with clear written instructions and emergency contact information for the on-call team 1. Specifically instruct them to return immediately if they develop:
- Persistent chest pain (transient pain may be normal, but persistent pain requires urgent evaluation) 1
- Breathlessness 1
- Fever or tachycardia 1
- Worsening choking or inability to swallow saliva 3
Dietary Modifications and Aspiration Prevention
Assess for aspiration risk, as dysphagia with choking sensation significantly increases risk of aspiration pneumonia 3, 4, 5. Consider:
- Referral to speech-language pathology for swallowing assessment if not already done 3
- Modified diet consistency (soft foods, thickened liquids) to reduce choking risk until definitive treatment 3, 6
- Upright positioning during and after meals 6
- Small, frequent meals rather than large boluses 6
Medication Review
Review all current medications for drugs that can worsen dysphagia 7:
- Anticholinergics (reduce esophageal motility and pharyngeal reflex) 7
- Sedatives (worsen swallowing coordination) 7
- Opioids (can cause esophageal dysfunction) 3
- Neuroleptics (can cause dysphagia through multiple mechanisms) 7
Symptom Management While Awaiting Procedure
Consider a trial of proton pump inhibitor therapy if not already prescribed, as gastroesophageal reflux disease is the most common cause of esophageal dysphagia and can cause sensation of throat swelling 3. This is reasonable while awaiting the scheduled procedure.
Monitor for red flags requiring urgent intervention before the scheduled procedure date:
- Complete inability to swallow (including saliva) - requires emergency evaluation 3
- Progressive worsening of symptoms 3
- Weight loss or dehydration 4, 5
- Signs of aspiration pneumonia (fever, cough, respiratory symptoms) 3, 4, 5
Common Pitfalls to Avoid
- Do not assume the sensation of "swollen throat" accurately localizes the pathology—distal esophageal lesions can cause symptoms perceived in the throat or neck 3
- Do not delay urgent evaluation if perforation is suspected—this is a medical emergency requiring immediate assessment by experienced gastroenterology and surgical teams 1, 2
- Do not overlook aspiration risk in patients with choking symptoms, as this significantly increases morbidity and mortality 3, 4, 5