One of the more important and critical referrals that otolaryngologists can receive
from colleagues in internal medicine, family medicine and geriatrics is the assessment
of swallowing problems or dysphagia of their patients.
The term dysphagia is derived from two Greek words which literally mean difficulty
in swallowing. Swallowing is a complex series of precisely coordinated voluntary and
involuntary muscular movements in the mouth, pharynx and esophagus that serves to
deliver food from the oral cavity into the stomach. Normal swallowing consists of three
phases: oral preparatory, pharyngeal and esophageal. One normal swallow of a bolus
of food should only take less than one second to reach the esophagus.
Dysphagia may manifest as difficulty managing secretions, drooling, delayed
swallowing, coughing or choking with the swallow, a wet gurgly voice and multiple
swallow attempts. The complaint of dysphagia in an elderly patient should not be
attributed to normal aging alone but should be considered an alarm symptom that
requires immediate definition of the exact cause and initiation of appropriate therapy.1