Evaluation methods

From discovery to clinical diagnosis Dysphagia is easy to diagnose in its a cute stage and when complicating a known neurological disease. However diag nosis may be greatly delayed when expressed by respiratory or nutritional s ymptoms, or when the patient presents cognitive disorders, as is frequent i n the elderly. In such instances, simple tests such as the water test are c learly indicated. However, although they are reliable for diagnosing dyspha gia, they are not precise in diagnosis of inhalation. Clinical examination is essential for diagnosing the etiology of the disorder. In the absence of clinical orientation, a nasofibroscopy is mandatory and digestive endoscop y debatable. Specialized examinations The first-line supplementary examination is a vide oradiography. It consists in the patient swallowing a liquid or solid bariu m sulfate bolus. This detects any anatomical or functional abnormalities. i t is the examination of choice for the diagnosis of inhalation and its mech anism. Videoendoscopy is complementary to videoradiography. it can be condu cted in first intention in patients who cannot be transported to the radiol ogy unit. it provides precise information on glottal closing and pharyngeal contraction. Impact on management In a restricted number of patients, the precise knowle dge of the mechanism of dysphagia can help to orientate specific treatment. In others, such examinations will orient re-education, postural adaptation and the modification of food texture. In many patients, precise diagnosis of the mechanism at the origin of dysphagia has no impact on the management of dysphagia, (C) 2001, Masson, Paris.