1. Mr Andrew Lale Consultant ENT surgeon
DYSPHAGIA
Mr Andrew Lale
Consultant ENT surgeon

5. SWALLOWING “5 minute consultation” CAUSES: Acute Neurogenic
Globus pharyngeus
Laryngopharyngeal reflux
Strictures and narrowing
Pharyngeal Pouches

6. CONSULTATION True Dysphagia or feeling of a lump? Dysphagia for what?
Regurgitation or Aspiration?
Gastro-oesophageal reflux current or past?
Change of Diet or weight loss?
Odynophagia

7. ACUTE DYSPHAGIA History: FB. Previous problems.
Examination: Drooling. Pain. Pyrexia. Odynophagia
Treatment:
Food bolus: Buscopan, fizzy drink, refer at 1 hour
FB: Refer

8. Foreign bodies

9. Strictures and narrowing
Malignant/benign
Cricopharyngeal bar
C-spine osteophytes
Kyphosis
Post cricoid web

10. Cricopharyngeal bar

11. Osteophytes

12. Neurogenic CVA Motor neurone disease Multiple Sclerosis
Parkinson’s disease
Myaesthena gravis

13. GLOBUS PHARYGEUS Previously Globus Hystericus
Worse when NOT eating or drinking
No true dysphagia solids/liquids
No odynophagia
No reguritation/aspiration
Variable history. ?exclude reflux…..

14. Laryngopharyngeal Reflux (LPR)
Reflux of gastric acid to larynx/pharynx
May be “silent”
Symptoms include feeling of a lump, odynophagia/chronic sore throat, chronic cough (especially nightime), hoarse voice and “mucous in throat”.

15. LPR Investigations Nasopharyngoscopy, red post cricoid region.
? Barium swallow?
Oesophageal pH manometry

16. LPR treatment 6 weeks PPI + Gaviscon initially
At review further 6 weeks treatment if improving
General laryngeal hygiene measures
If no better, rigid pharyngo-oesophagoscopy
pH manometry ?fundoplication

17. Pharyngeal pouches HISTORY Long Hx dysphagia
Regurgitation esp at night
“gurgling” swallow
Aspiration (recurrent pneumonia)
Weight loss and change in Diet.

18. Pharyngeal Pouches EXAMINATION Nasopharyngoscopy might show pooling
Unlikely to feel anything in neck
Barium swallow

19. Pharyngeal pouches TREATMENT Surgical if fit for GA
(External approach)
Endoscopic stapling, low morbidity and high success rate.

20. Pouches

21. Pouches

22. Summary :Fast track patients
Young male patient
Short history
Odynophagia
Smoking and Alcohol
Weight loss
Aspiration and reguritation

23. Summary: Globus patients
Variable history
No true dysphagia
Young female
No weight loss
Associated anxiety

24. Summary: Pouch patients
Older male/female
REGURGITATION
Gurgling swallow
Recurrent chest infections
Weight loss

25. Thankyou