Troubles de la déglutition de l'adulte. Prise en charge diagnostique et thérapeutique

Swallowing disorders impair the normal process which drives the oral content to oesophagus and stomach and protects the airway. Impairment of the initial stages of the process disturbs the pharyngo-laryngeal stages. Symptoms are dysphagia and aspiration with possible life-threatening complications. Pharyngo-oesophageal cancers and neurological diseases are major causes of swallowing disorders. Otolaryngological assessment and oesophageal fibrescopy are necessary to detect a tumour. Neurological examination is necessary to detect neurological diseases. Functional assessment of the swallowing consists in swallowing observation, nasofibrescopy of the pharyngo-larynx during swallowing and videofluoroscopy when upper oesophageal sphincter assessment is necessary. Manometric techniques are useful in assessing the oesophageal body impairment but are poorly effective in assessing the pharynx and upper oesophageal sphincter. Available treatments are diet, re-education, non-oral feeding techniques, functional surgery (cricopharyngeal myotomy) and palliative surgery (tracheotomy, gastrostomy, laryngeal closure).