1. difficulty in swallowing
   1. choking
   2. coughing
   3. pain
2. Oropharyngeal dysphagia
   1. problem emptying material from oropharynx into esophagus
   2. Etiology
      1. neurological
         1. stroke
         2. parkinson dz
         3. MS
      2. muscular
   3. Signs & Sx
      1. trouble initiating swallowing
      2. nasal regug
      3. coughing or choking w. swallowing
      4. food sticking in the throat
      5. hypersalivation (sialorrhea)
      6. unexplained wt loss
      7. recurrent peumonia
      8. wet voice
   4. DDX
      1. stroke
      2. parkinson dz
      3. brainstem tumor
      4. Degenerative dz
         1. MS, ALS, Huntington
      5. Syphilis
      6. achalasia
3. Esophageal Dysphagia
   1. Signs & Sx
      1. food sticking in chest or throat
      2. oral or pharyngeal regurg
      3. recurrent pneumonia
   2. Etiology
      1. motility disorder
         1. achalasia
         2. scleroderma
         3. solids and liquids
      2. mechanical obstruction
         1. carcinoma
         2. usu affects solids only
   3. DDX
      1. Achalasia
      2. Scleroderma
      3. Tumors
4. Physical Examination
   1. CN V, VII, XII
      1. dysphonia
         1. voice disorder
      2. dysarthria
         1. trouble articulating
   2. observe mouth movements
   3. assess resp. fxn
      1. assess risk of aspiration
   4. observe act of swallowing
      1. Sialorrhea
      2. delayed swallow initiation
      3. coughing
         1. wait 1 min. after swallow
   5. wet/hoarse voice