specific reversible etiology of OPD, such as thyroid hormone replacement in patients with thyroid‐induced myopathy resulting in OPD, may result in resolution or amelioration of OPD.
Diet and lifestyle
The patient’s diet is dictated by the nature of their OPD. While some patients can tolerate a regular diet, others require soft or pureed foods because they cannot form a cohesive bolus or they have a defective preparatory phase of swallowing. A simple intervention consists of manipulation of bolus size and consistency. However, dietary modification should not compromise the patient’s pleasure in eating. Patients’ families should be advised to make every effort to ensure desirability and palatability of meals by paying particular attention to taste, temperature, and texture, as well as being tolerant about the extra time required for some patients to eat properly. The overall goals of dietary intervention are to afford adequate nutrition while minimizing the sometimes dramatic personal and social ramifications of OPD, and thus allow patients to comfortably function within their social milieu.
Conclusions
In conclusion, OPD results from dysfunction of one or more of the highly coordinated events of the oropharyngeal phase of swallowing, leading to abnormal transport and/or airway protection. Whether due to one of a variety of muscular disorders, peripheral and central nervous system disorders, malignancies of the oropharyngeal cavity, or surgical and radiation therapy for these malignancies, the symptoms of OPD are highly specific and should not be dismissed as psychogenic. Physical examination should focus on detection of neurologic deficits. Although several useful diagnostic modalities are available, the video‐fluoroscopic recording of a modified barium swallow is the diagnostic modality of choice for initial investigation of the patient with OPD. Diagnosis and optimal management of OPD require a systematic approach by a well‐trained multidisciplinary team under the guidance of a single managing physician.
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