Definitions

Dysphagia is difficulty swallowing. Globus is a sensation of a lump in the throat. Odynophagia is pain on swallowing.

Aetiology

Swallowing problems can be caused by obstruction within the pharynx and oesophagus (intraluminal), by external pressure on the pharynx and oesophagus by a neck or mediastinal mass (extraluminal) or by neurological disorders that affect the swallowing muscles (intramural; Figure 25.1). The history should include pertinent questions to help to identify the cause:

• Degree of dysphagia: solids, tablets, liquids, saliva.
  
• Does the patient have difficulty making the movements of swallowing: this can help differentiate a physical obstruction from a neurological cause.
  
• Level of dysphagia: in the neck, upper, mid or low chest.
  
• Timescale of symptoms: how long has the patient had symptoms for?
  
• Presence of odynophagia: is there any pain on swallowing?
  
• Weight loss: the amount of weight loss if this can be quantified.
  
• Voice change: hoarseness.
  
• Smoking and alcohol history.
  
• Associated symptoms: including otalgia, regurgitation of food or liquids, other neurological symptoms.

Foreign Body

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