Diagnosis in Muscle Tension Dysphagia

Introduction: Patient-reported outcome measures have been used within the otorhinolaryngologic disorders' field for many years to compare patient's perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term - dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation. Aim: Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia. Material and method: The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist's examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms. Results: The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function. Conclusions: The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.