Читать книгу The Esophagus - Группа авторов - Страница 75

The evaluation of OPD begins when the patient enters the room, with appearance and gait. A thorough neuromuscular examination is essential as many causes of OPD will have systemic findings. The oropharynx should be inspected for dentition, symmetry, as well as the presence of saliva. Xerostomia is a common cause of OPD in the elderly. This finding should be followed by eye evaluation, joint examination, and a careful history regarding anticholinergic medications and head and neck surgery or radiation. Change in voice such as hoarseness or nasal speech may be observed with nerve dysfunction and soft palate dysfunction, respectively. The neck should be palpated for masses. Before proceeding to a radiologic test or swallow study, it is helpful to ask the patient to perform a dry swallow in the office for visual inspection of movement and symmetry, and with gentle pressure on the thyroid cartilage and hyoid bone. Normal movement is elliptical antero‐superior motion. Abnormal ascent is seen in neurologic disorders.