Treatment of Oropharyngeal Dysphagia.

Substantial ignorance and controversy surround the management of neuromyogenic pharyngeal dysphagia. The major obstacle to confident recommendations is the lack of high-level evidence supporting most available therapies. There is reasonable evidence supporting cricopharyngeal disruption (myotomy or dilatation) in primary restrictive disorders of this region, but low-level evidence supporting myotomy in pure neuromyogenic dysphagia. There is reasonable evidence supporting current dietary recommendations as aspiration-minimization strategies. There is only low-level evidence, albeit consistent, to support swallow-behavior modification therapies. The type of therapy needs to be tailored to the individual and depends upon many variables, including cognitive ability, severity and mechanics of pharyngeal dysfunction, and the perceived safety of continued oral feeding. One or more of these strategies are recommended where appropriate because where the level of evidence is low, it is at least consistently favorable and such therapies have not been proven to be ineffective.