Author: Michelle Lin, MD
Updated: 2/3/2010


Oropharyngeal Dysphagia


  • Difficulty initiating swallowing
  • May include coughing, choking or nasal regurgitation

Mechanical obstruction

  • Tumor, inflammatory masses
  • Trauma/ surgical resection
  • Zenker's diverticulum
  • Esophageal webs
  • Extrinsic structural lesions
  • Anterior mediastinal masses
  • Cervical spondylosis

Neuromuscular disorder

  • CVA (common cause)
  • Parkinson's disease
  • Brain stem tumors
  • Degenerative disease (ALS, multiple sclerosis, Hungtington's)
  • Post-infectious (polio, syphilis)
  • Peripheral neuropathy
  • Myasthenia gravis
  • Myopathies
  • Cricopharyngeal disease
  • Achalasia

Esophageal dysphagia

Esophageal dysphagia workup flowchart

Approach to dysphagia

  1. Determine first if patienthas oropharyngeal versus esophageal dysphagia.
  2. Determine ifmechanical (problem issolid foods only) versus neuromuscular(problem with liquids and solids) is more likely.


  • Medications can causedysphagia fromesophageal mucosalinjury or reduced lower esophageal sphinctertone.
  • CVA is most commoncause of oropharyngealdysphagia

Workup for dysphagia

  • Endoscopy
  • Barium swallow
  • Consider esophageal pH probe, manometry


  • Spieker MR.Evaluating dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-48. [PubMed]