Health ProfessionsNeurologySpeech-language PathologyDysphagiaNeuromuscular DisordersPulmonologyClinical Swallowing EvaluationDysphagia AssessmentEsophageal DysphagiaNeurolaryngeal DisordersOropharyngeal DysphagiaVideofluoroscopic Swallow StudyCricopharyngeal AnatomyHypopharyngeal AirwayPharyngeal DysphagiaSwallowing Fluoroscopy
WHEN the patient with parkinsonism develops dysphagia, it is almost always hypopharyngeal dysphagia. Fortunately, this is not a common problem in parkinsonism, for the tracheopulmonary consequences are potentially disastrous, and the patient's distress is almost unbearable. For the individual patient, efforts to pin down the cause of the dysphagia have often left the clinician uncertain. The reason is that cinefluoroscopy, ordinarily an excellent method for investigating hypopharyngeal dysphagia, proves strangely difficult to interpret when there is parkinsonism. "Neuromuscular incoordination" is about as far as the interpretation can go. When the fuzziness of cinefluoroscopy is replaced by the sharpness and clarity of the 105-mm 6 or 12/sec photofluoroscopic technique, however, it becomes clear that the whole problem is caused simply by classical cricopharyngeal achalasia. In this form of hypopharyngeal neuromuscular incoordination, the cricopharyngeus muscle either does not open quickly enough as the bolus descends through the pharynx or it closes again