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

Functional dysphagia is defined as a persistent or recurrent sensation of abnormal bolus passage without demonstrable structural, inflammatory, or major neuromuscular abnormality. Despite its clinical relevance, otolaryngologic reports of this condition remain limited.

We describe a 71-year-old man who presented with progressive swallowing difficulty following a self-limited pharyngeal infection. He reported severe subjective difficulty swallowing solids and restricted his diet to liquids. Flexible nasolaryngoscopy, videoendoscopic evaluation of swallowing (Hyodo score 1), videofluorographic swallowing study (VFSS), upper gastrointestinal endoscopy, and neurological evaluation were all essentially normal. No aspiration was documented. Functional dysphagia was diagnosed based on the marked discrepancy between symptom severity and objective findings. Conservative management with reassurance and gradual reintroduction of oral intake resulted in progressive recovery over 4 months.

Functional dysphagia should be considered when subjective swallowing difficulty is disproportionate to objective findings. Recognition of this discrepancy prevents overtreatment and supports multidisciplinary management targeting sensory-perceptual recalibration rather than anatomical correction.