How is dysphagia diagnosed?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

History and physical examination alone may not be adequate to make a diagnosis in cases of silent aspiration. Further diagnostic tests, such as the following, should be performed as needed:

  • Transnasal esophagoscopy: Especially useful in cases of esophageal diverticula or tumor [41]

  • Cervical auscultation: Permits the clinician to assess pharyngeal swallow by listening to stereotypical sounds through a stethoscope; cervical auscultation may be a useful bedside tool, especially in the absence of other diagnostic tools

  • Blood tests: Including thyroid-stimulating hormone, vitamin B-12, and creatine kinase; may be useful, especially in neurogenic dysphagia

  • Imaging studies: May include videofluoroscopy, CT scanning, MRI, chest radiography

  • Endoscopic examination

  • Esophageal pH monitoring: The criterion standard for diagnosing reflux disease; a nasogastric probe is inserted into the patient's esophagus to record pH levels, and these are compared with the patient's record of symptoms over 24 hours to determine whether acid reflux contributes to the patient’s symptoms

  • Pulmonary function tests

The above list of tests is not exhaustive, and further tests may be required if there is a need to follow up on other associated findings during the initial evaluation. Consultations with and further evaluations by an ear, nose, and throat (ENT) surgeon and a speech-language therapist also may be necessary.


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