| What does it feel like? |
— The patient cannot initiate a swallow, or food feels like it is hanging in the neck. |
— After swallowing, food sticks behind the sternum or in the epigastrium or, less commonly, in the neck. |
| When does it occur? |
— Within 1 second of an attempted swallow |
— A few seconds after swallowing |
| Are there associated symptoms or conditions? |
— Inability to chew or propel the bolus — Sialorrhea, drooling, or food spillage — Coughing, choking, or nasal regurgitation — The need to swallow repeatedly to clear food from the pharynx — Hoarseness, slurred or nasal speech, dysarthria, or dysphonia — Referred otalgia may indicate a cancer of the hypopharynx, larynx, pharynx, or tongue base. — Prolonged intubation — Head and neck surgery or radiation — Swallowing with gurgling noise, sensation of fullness in the neck, halitosis, and late regurgitation of undigested food may point to a Zenker diverticulum.
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— Chest pain — Nocturnal or late regurgitation of undigested food — Chronic heartburn, hematemesis, coffee ground emesis, and anemia may point toward GERD complications; however, the presence or absence of heartburn is not specific. — Dysphagia to both solids and liquids from the onset indicates a motility disorder. — Progressive dysphagia from solids to liquids suggests a structural lesion (stricture, ring, web, or tumor). — Intermittent dysphagia to solids without significant weight loss is often related to an esophageal ring. — Odynophagia is often indicative of esophageal inflammation (erosive, pill-induced, or infectious), esophagitis, or caustic ingestion.
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| How is relief achieved after the bolus impaction? |
— Repeated swallowing, raising the arms, throw ing shoulders back, or performing the Valsalva maneuver — Ability to expectorate the offending bolus
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— Regurgitation or vomiting |
| Do you have a systemic illness? |
— Stroke, Parkinson disease, myasthenia, multiple or amyotrophic lateral sclerosis, thyrotoxicosis, and other related conditions |
— Collagen vascular diseases such as scleroderma, CREST syndrome, rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome |
