Swallowing disorders in the ambulatory medical setting

Abstract

Objectives: The aims of this cross-sectional study were to explore the nationwide number and demographics of patient visits due to dysphagia and to investigate potential differences in their management between otolaryngologists and other physicians in the outpatient setting.

Study design: Cross-sectional.

Setting: National Ambulatory Medical Care Survey.

Subjects and methods: The data sets from 2007 to 2010 were queried to extract all cases with dysphagia as a reason for visit. Data regarding demographics, imaging studies, nonmedication therapies, diagnoses, medications, and patient disposition were compared between otolaryngologists, primary care physicians, and other specialists.

Results: Annually, 1,875,187 (95% confidence interval [CI], 1,443,876-2,307,204) outpatient visits were due to dysphagia, comprising 0.19% of all visits (95% CI, 0.14%-0.23%) and 1.55% (95% CI, 1.10%-2.0%) of the visits to otolaryngologists. The visits were mostly distributed between primary care physicians and other specialists, while 16.4% (95% CI, 11.3%-21.6%) visited an otolaryngology office. Otolaryngologists, primary care physicians, and other specialists ordered imaging studies in 22.8%, 10.2%, and 24.0% (P = .02); performed aerodigestive-specific procedures in 20.8%, 4.0%, and 36.2% (P < .0001); and referred the patient to another physician in 5.8%, 14.8%, and 2.8% (P = .003) of the visits, respectively.

Conclusions: Almost 0.2% of office visits to physicians have a complaint of dysphagia. Otolaryngologists are involved in the care of a minority of these visits. The differences in the management of dysphagic patients may be due to different etiologies of the disease.

Keywords: ambulatory care; dysphagia; esophageal reflux; otolaryngology–head and neck surgery.