Values and limitations of pharyngolaryngoscopy (transnasal, transoral) in patients with dysphagia

During the last decade, videoendoscopic evaluation of structures and sensor imotor functions of the pharynx and larynx has been established as a valuab le tool in the assessment of dysphagia. This method is feasible at a very e arly stage and in critically ill patients, is not invasive and frequently r epeatable. Several authors described the high sensitivity and specificity o f this method in detecting the presence of the most important symptoms of s wallowing dysfunction: retention, penetration and aspiration. In our study of 39 patients with neurogenic dysphagia, we found high agreement between t he results of videoendoscopic and videofluoroscopic examination regarding t he registration of the most critical symptom, i.e. aspiration. Moreover, we observed patients who aspirated only their saliva and whose endoscopically verified aspiration problem remained undetected by radiographic examinatio n, probably due to the lower sensory input of saliva as compared to a contr ast medium. Since the detection of aspiration of saliva is of high clinical relevance for pulmonary function, the endoscopic examination turned out to be superior, in this particular respect, to the radiographic examination. However, the method fails to provide sufficient information regarding the c ause of the observed symptoms or the amount of aspirated material. Six pati ents in our study exhibited, in addition to the neurological signs, structu ral changes (diverticula, pouches) or unexpected functional esophageal dist urbances (persistent opening of the upper esophageal sphincter, retrograde peristalsis) which could only be detected by radiographic examination. The two methods should therefore be considered complementary.