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Inflammatory Causes of Dysphagia in Children
Gastroesophageal reflux (GER) and eosinophilic esophagitis (EoE) are the most common inflammatory causes of pediatric dysphagia, but several other less prevalent conditions should be considered. These conditions can affect one or several aspects of the swallowing process. In some inflammatory conditions dysphagia may be an early symptom. Esophagoscopy and instrumental swallow studies are often needed to determine the underlying diagnosis and best treatment plan. In some inflammatory conditions dysphagia can portend a worse outcome and need for more aggressive treatment of the underlying condition. Consultations with speech...
Source: Otolaryngologic clinics of North America - April 17, 2024 Category: ENT & OMF Authors: Marisa A. Ryan, Anna Ermarth Source Type: research

Oral and Pharyngeal Dysphagia in Adults
Patients with oral and pharyngeal dysphagia have difficulty forming a cohesive bolus and/or transferring food from the mouth into the pharynx and esophagus to initiate the involuntary swallowing process. This may be accompanied by nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Abnormalities affecting the upper esophageal sphincter, pharynx, larynx, or tongue, in isolation or combination, result in oropharyngeal dysphagia affecting either or both transit and airway protection. These issues can be addressed with a combination of management of the underlying systemic disea...
Source: Otolaryngologic clinics of North America - April 17, 2024 Category: ENT & OMF Authors: Karuna Dewan Source Type: research

Assessing Dysphagia in the Adult
This article explores the landscape of dysphagia assessment in adults. Dysphagia, a complex condition affecting the lifespan and many health conditions, significantly compromises individuals ’ quality of life. Dysphagia is often underdiagnosed, emphasizing the need for comprehensive assessment methods to ensure timely and accurate intervention. It encompasses clinical history, physical examination, clinical and instrumental swallow evaluations. Procedures within each of these modaliti es are reviewed, highlighting strengths, limitations, and contribution toward a complete understanding of dysphagia, ultimately guiding ef...
Source: Otolaryngologic clinics of North America - April 16, 2024 Category: ENT & OMF Authors: Laurence Gascon, Paul C. Bryson, Michael Benninger, Martin B. Brodsky Source Type: research

Esophageal Dysphagia in Adults
This article underscores the role of detailed patient history and physical examinations, including prompt endoscopic evaluation, for accurate differentiation between esophageal and oropharyngeal dysphagia. The authors discuss the heightened importance of early intervention in certain patient groups, such as elderly individuals and patients with head and neck cancer, to mitigate the risk of malnutrition and infection. The authors delve into etiologic factors highlighting the complexity of clinical presentations and the significance of tailored management strategies. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 10, 2024 Category: ENT & OMF Authors: Miller Richmond, Elliana Kirsh DeVore, Phillip C. Song Source Type: research

Pediatric Esophageal Dysphagia
Swallowing is an elaborate process that requires neuromuscular coordination. Pediatric esophageal dysphagia is broadly categorized into structural and nonstructural causes. The structural causes of pediatric esophageal dysphagia are related to processes that narrow the lumen of the esophagus. Esophageal strictures are the result of scar tissue formation within the lumen of the esophagus, leading to stenosis. Vascular rings and slings cause external compression of the esophagus. Diagnosis requires an esophagram and computed tomography or magnetic resonance imaging. Treatment is guided by the patient ’s symptoms and underl...
Source: Otolaryngologic clinics of North America - April 3, 2024 Category: ENT & OMF Authors: Erin R.S. Hamersley, Cristina Baldassari Source Type: research

Neurogenic Dysphagia
This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson ’s disease, amyotrophic lateral sclerosis, and multiple sclerosis. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 3, 2024 Category: ENT & OMF Authors: Swapna K. Chandran, Manon Doucet Source Type: research

Dysphagia as a Manifestation of Endocrine and Metabolic Disorders
Dysphagia is a common manifestation of endocrine and metabolic diseases. Swallowing is a complex neuromuscular process, with an interplay of sensory and motor function, that has voluntary and involuntary control. Disruptions in any of these processes can cause significant dysphagia. Endocrine disorders and metabolic derangements are systemic conditions that affect multiple organ systems. They contribute to the development of neuropathies, myopathies, and motility disorders that lead to swallowing difficulty. Malnutrition and critical illness can lead to deconditioning and atrophy which can cause dysphagia, which in turn ca...
Source: Otolaryngologic clinics of North America - April 3, 2024 Category: ENT & OMF Authors: Chloe Santa Maria, Karla O ’Dell Source Type: research

Adenotonsillectomy for Obstructive Sleep Apnea in Children
Obstructed breathing is the most common indication for tonsillectomy in children. Although tonsillectomy is performed frequently worldwide, the surgery is associated with a number of significant complications such as bleeding and respiratory failure. Complication risk depends on a number of complex factors, including indications for surgery, demographics, patient comorbidities, and variations in perioperative techniques. While polysomnography is currently accepted as the gold standard diagnostic tool for obstructive sleep apnea, studies evaluating outcomes following surgery suggest that more research is needed on the ident...
Source: Otolaryngologic clinics of North America - April 3, 2024 Category: ENT & OMF Authors: Samantha L. Jaensch, Alan T. Cheng, Karen A. Waters Source Type: research

Zebras in Adult Dysphagia Workup
While many patients who present with dysphagia have a clinically identifiable cause of dysphagia, the etiology of swallowing difficulty is oftentimes a diagnostic enigma. The aim of this article is to review possible etiologies of dysphagia when objective evidence of dysphagia is lacking. Included in this discussion are cricopharyngeal spasm, retrograde cricopharyngeal dysfunction, muscle tension dysphagia, dysphagia secondary to medications, and functional dysphagia. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 3, 2024 Category: ENT & OMF Authors: Melin Tan-Geller Source Type: research

Comorbid Insomnia and Sleep Apnea
Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Cognitive behavioral therapy for insomnia is the first line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA). Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical tre...
Source: Otolaryngologic clinics of North America - March 26, 2024 Category: ENT & OMF Authors: Kathleen M. Sarber, Reena Dhanda Patil Source Type: research

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond T & A – Tongue Base and Larynx
Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct the surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplas...
Source: Otolaryngologic clinics of North America - March 26, 2024 Category: ENT & OMF Authors: Matthew Maksimoski, Carol Li Source Type: research

Neurostimulation for Obstructive Sleep Apnea
Neurostimulation of hypoglossal nerve has emerged as an effective treatment option of obstructive sleep apnea (OSA). Since FDA approval in 2014, therapy has been widely used in select patients with moderate-to-severe OSA who do not benefit from positive airway pressure. Ongoing research and technological developments continue to advance the therapy to deliver personalized and efficient treatment to patients with OSA. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 23, 2024 Category: ENT & OMF Authors: Maria V. Suurna, Mia Klasner Source Type: research

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Tonsillectomy & Adenoidectomy
Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplasty m...
Source: Otolaryngologic clinics of North America - March 23, 2024 Category: ENT & OMF Authors: Matthew Maksimoski, Carol Li Source Type: research

Management of Obstructive Sleep Apnea in the Infant and Newborn
Obstructive sleep apnea in newborns and infants presents a unique challenge with distinct differences in sleep physiology, etiologies, and management compared to older children. The indications for and interpretation of polysomnography are less well defined in infants. There are also no broadly accepted clinical practice guidelines for treating sleep apnea in this age group. Etiologies include general causes of upper airway obstruction in infants such as laryngomalacia, micrognathia, and nasal obstruction in addition to adenotonsillar hypertrophy. Treatment strategies must be tailored to the specific anatomic features and ...
Source: Otolaryngologic clinics of North America - March 23, 2024 Category: ENT & OMF Authors: Jillian N. Sanford, Derek J. Lam Source Type: research

Advances in Pharyngeal Surgery Over the Past 10  Years
This article is a review of advances in pharyngeal surgery over the past 10  years regarding literature, surgical technique, assessment, collaboration, and future direction in the management of adult and pediatric obstructive sleep apnea. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - March 23, 2024 Category: ENT & OMF Authors: Stuart G. Mackay, James D. Every Source Type: research