Clinical approach to the dysphagic patient

Dysphagia is a symptom of disease reflecting either structural or neuromuscular disorders of the oropharynx or esophagus. Dysphagia should be distinguished from globus sensation and odynophagia. The clinical evaluation of the dysphagia patient by the otolaryngologist requires taking a detailed history of the complaint, extended ENT physical examination, fiberoptic nasopharyngolaryngoscopy, to assess the oral and pharyngeal phases of swallowing. Special investigations including radiography, esophageal endoscopy, ultrasonography, pH metry, manometry may be needed for the full diagnosis. It is essential for the otolaryngologist to develop a close working relationship with the radiologist, gastroenterologist, neurologist and swallowing therapist. This team approach will allow in most of the patients with dysphagia not only to identify the cause of the complaint but also to implement an effective treatment.