Functional Dysphagia Presenting With Severe Subjective Swallowing Difficulty Despite Minimal Objective Findings: A...

Area of Science:

• Otolaryngology
• Gastroenterology
• Neurology

Background:

• Functional dysphagia involves a sensation of abnormal swallowing without identifiable structural or neuromuscular issues.
• Otolaryngologic literature on functional dysphagia is limited despite its clinical significance.

Purpose of the Study:

• To present a case of functional dysphagia.
• To highlight the diagnostic challenge posed by the discrepancy between subjective symptoms and objective findings.

Main Methods:

• A case presentation of a 71-year-old male with progressive swallowing difficulty.
• Utilized flexible nasolaryngoscopy, videoendoscopic swallowing evaluation (Hyodo score 1), videofluorographic swallowing study (VFSS), upper gastrointestinal endoscopy, and neurological evaluation.
• Diagnosis based on significant disparity between reported symptoms and normal objective test results.

Main Results:

• Objective swallowing evaluations were essentially normal, with no aspiration documented.
• The patient reported severe difficulty with solids, restricting intake to liquids.
• Functional dysphagia was diagnosed due to the discrepancy between symptom severity and objective findings.

Conclusions:

• Functional dysphagia should be suspected when subjective swallowing complaints are disproportionate to objective findings.
• Recognizing this discrepancy can prevent unnecessary interventions and guide management.
• Multidisciplinary care focusing on sensory-perceptual recalibration is recommended over anatomical correction.