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                   Anatomy and Physiology of Swallowing

Endoscopic Evidence of Dysphagia

1. Pooling of saliva at hypopharynx.

2. Reduced or absent of pharyngeal wall contraction upon prolonged/forceful phonation.

3. Rising tide signs which is regurgitation of refluxate emerging from upper oesophageal opening.

4. Reduced or absent adductor laryngeal reflex upon puff of air stimulaton or upon direct mucosal contact.

5. Panetration or direct observation of aspiration.


Pooling of Saliva:Endoscopic Appearance of Hypopharynx




Obvious pooling of saliva at both pyriform fossa [(+) - bottom figure] in a patient who has an upper oesophageal stricture and anterior cervical fusion plates for fractures of cervical spine.  Compare with normal appearance above.

Pooling of Saliva in Hypopharynx

Figure shows cumulation of saliva in the hypopharynx caused by pseudobulbar palsy.  Dysphagia, dysphonia, and aspiration are the main issues that need wholesome management.

Dysphagia: Cranial Nerves IX, X Palsies (Left-sided)

           Glottic gap upon phonation                           Soft palate asymmetry.

          obvious pooling of saliva, and

          absent pharyngeal contraction.

Nasogastric Tube In-Situ: Hypopharyngeal View

Flexible Transnasal Endoscopic Guided Nasogastric Tube Insertion

Fibreoptic Endoscopic Evaluation of Swallowing (FEES)


 Normal swallowing

 FEES: Complete clearance of solid food (coloured rice grain).

 FEES: Inability to clear colored food (pureed rice) upon act of swallowing.


FEES: Inability to swallow liquid even after several attempts.

Cricopharyngeus Dysfunction

Oesophageal Spasm

GERD and Barrett's Oesophagus

Barium Swallow: Achalasia Cardia

Swallowing Difficulty Due To Fungus: Endoscopy

Normal Swallowing with Modified Barium Swallow

Oesophageal Manometry

What is Impedance?

Dysphagia - The Pureed Diet Made Easy