12-minute consultation: an evidence-based approach to the management of dysphagia

Dysphagia is frequently encountered by the otolaryngologist and due to its diverse aetiologies often poses a diagnostic challenge. Of particular importance in diagnosis is to distinguish between oropharyngeal and oesophageal dysphagia. This article aims to provide a systematic, concise and evidence-based method of managing the patient with dysphagia.

This review was based on a literature search last undertaken on 15 January 2013. The MEDLINE, EMBASE and Cochrane databases were searched using the subject heading dysphagia in combination with classification, diagnosis, investigations, management, treatment and surgery. Results were limited to English language articles including case series, clinical trials, randomised controlled trials, meta-analyses, systematic reviews and review articles. Relevant references from selected articles were also reviewed.

The majority of published literature for dysphagia is of level II/III evidence, with 16 relevant randomised controlled trials identified. The clinical history is of paramount importance in delineating the cause of dysphagia. There is no significant difference regarding the diagnostic efficacy of fibreoptic endoscopic evaluation of swallowing compared to videofluoroscopy, and where indicated and practicable, these investigations complement each other. In general, structural causes of dysphagia are managed surgically, whereas swallowing therapy is efficacious in managing dysphagia due to neuromyogenic disorders.

A structured history of dysphagia and its associated symptoms, flexible laryngoscopy and endoscopic assessment of swallowing where relevant in addition to targeted investigations should lead to the correct diagnosis and appropriate management.