As part of the diagnostic process, it is important to consider whether the globe discomfort occurs during empty swallowing or during eating. Functional complaints usually do not become apparent when swallowing food.
First, organic causes should be ruled out. This is followed by functional examinations of the voice and swallowing.
Mandatory medical device diagnostics.
- Transnasal video endoscopy – is considered a standard examination of swallowing.
- Flexible endoscopic evaluation of the swallowing act (FEES) – for this purpose, a flexible laryngoscope (laryngoscopy) is positioned after passage through the inferior nasal meatus so that the view of glottis (voice-forming part of the larynx) and adjacent structures is possible; then test meals of different consistencies are offered and their swallowing is observed – for objective evaluation of the swallowing act
- Esophageal Breischluck – in cases of suspected dysfunction of the esophagus (esophagus) and oropharyngeal dysphagia (swallowing difficulties affecting the mouth and pharynx).
Optional medical device diagnostics – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification.
- Videofluoroscopic evaluation of the swallowing act (“videofluoroscopic swallowing study”, VFSS): contrast-enhanced radiological examination method of swallowing – for objective evaluation of the swallowing act; videokinematography is also possible but has a lower resolution
- X-ray of the thorax (X-ray thorax/chest), in two planes – if mediastinal tumor is suspected (tumor located between the right and left lung and bounded anteriorly by the sternum, and posteriorly by the spine)
- X-ray examination of the swallowing act (barium pre-swallow).
- Computed tomography (CT; sectional imaging procedure (X-ray images from different directions with computer-based evaluation)) of the head, neck, thorax (chest cavity), abdomen (abdominal organs) – for suspected neoplasms, neurological diseases.
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging (by means of magnetic fields, that is, without X-rays); particularly well suited to the representation of soft tissue injuries) of the head, neck, thorax (chest cavity), abdomen (abdominal organs) – on suspicion of neoplasms, neurological diseases.
- Thyroid sonography (thyroid ultrasound) – when thyroid disease is suspected.
- Esophago-gastro-duodenoscopy (ÖGD; reflection of esophagus, stomach and duodenum) – to exclude pathological (pathological) changes and dysfunction of the esophagus; if necessary, with biopsies (tissue sampling) from all suspicious lesions.
- Laryngostroboscopy (laryngeal stroboscopy) – for voice strain and hoarseness; used to assess vocal fold function during phonation: regular stroboscopic examinations allow early detection of infiltrative vocal fold processes. Mucosal changes that infiltrate the vocal fold muscles lead to a stroboscopic (phonatory) arrest. If this stagnation persists for 2-3 weeks, the indication for microlaryngoscopic trial excision is given.
- Voice field measurement (method by which the pitch and volume of the voice is measured and displayed in a so-called phonetogram) – for voice strain and hoarseness.
