Swallowing disorders: Diagnosis and Therapy

Otolaryngologist-head and neck surgeons are frequently asked to assist in the management of patients with difficulty swallowing.Deglutition is a complex neuromuscular act involving many structures in the oral cavity, pharynx, larynx, and esophagus, which are controlled by a number of cranial nerves.It has both volitional and reflexive components that must perform with great precision and rapidity.The causes of dysphagia are protean, crossing the boundaries of expertise of a wide variety of clinical specialties.Patients with swallowing problems are best served by a multidisciplinary team including the primary care physician and specialists from gastroenterology, radiology, otolaryngology, neurology, thoracic surgery, dentistry/prosthodontics, speech pathology, rehabilitation medicine, and nutritional science.Otolaryngologists possess expertise in the anatomy and neurophysiology of the upper aerodigestive tract and the disorders that affect it.They also possess the skills necessary to examine and intervene surgically in this area.Dysphagia is often accompanied by other problems such as hoarseness, airway obstruction, and pain, for which otolaryngologic consultation may be vital.Thus, an otolaryngologisthead and neck surgeon should participate in the workup and management of any patient with swallowing difficulties involving the upper aerodigestive tract.