Diagnosis, Treatment of Swallowing Disorders Require Focused Evaluation by Otolaryngologists

Swallowing problems are often serious, and diganosis and treatment can be difficult.

VANCOUVER—Difficulty swallowing is one of the most serious problems otolaryngologists see, and navigating the terrain of diagnosis and treatment can involve assessing factors that are sometimes subtle, a panel of experts said here at the 2013 AAO-HNS Annual Meeting.

“It is the one diagnosis in our specialty that kills more patients than any other,” said panel moderator Catherine Lintzenich, MD, associate professor of otolaryngology at Wake Forest Baptist Medical Center in Winston-Salem, NC, to the session audience. “I feel very strongly that no other specialty or physician out there is better equipped to evaluate and treat swallowing problems than [otolaryngologists].”

Panelists included Albert Merati, MD, chief of laryngology at the University of Washington School of Medicine in Seattle; Greg Postma, MD, director of the MCG Center for Voice and Swallowing Disorders at Georgia Regents Health System in Augusta; and Milan Amin, MD, director of the New York University Voice Center.

Dr. Lintzenich said patients often come to her after doctors in other subspecialties check on a few specific issues and don’t uncover the problem. “If you don’t help them with their swallowing problem, you can be 100 percent positive that there’s really nobody else who will, nobody else who can and certainly nobody else who wants to,” she said.

The panelists made observations and drew lessons from several cases.

Case 1

The first was a 54-year-old man with a six-month history of food sticking in the throat and a cough. He’d had no voice changes. He had a history of high blood pressure, reflux, arthritis and a cervical spine fusion 15 years earlier.

Dr. Lintzenich said that when getting the patient history it’s important to specifically ask about weight loss and infections directly. “They often do not volunteer that information,” she said.

The panelists said that the pharyngeal squeeze maneuver, meant to gauge the pressure that can be generated by the pharynx by observing when a patient makes a high-pitched “E” sound, is a useful tool. Dr. Merati said it’s fast and easy to do, and studies have found correlation with manometry readings and predicts, at least anecdotally, success in some swallowing operations. “It is very helpful,” he said. “Do not underestimate it.”

Asked about the instrument evaluation of choice, Dr. Postma said that the most reasonable choice would probably be an endoscopic swallow evaluation. Dr. Merati added, though, that fiberoptic endoscopic evaluation of swallowing (FEES) probably could be skipped if you’re sure you’ll perform a modified barium swallow.