Swallowing disorder is a sensation of obstruction in the pharynx, posterior sternum or esophagus due to obstruction in the transport of food from the oral cavity to the cardia and stomach. Normal human swallowing is divided into oral phase, pharyngeal phase and esophageal phase. Problems in any of these phases can lead to swallowing disorders. The pharynx is the common channel for breathing air and swallowing food, and the coordination of breathing and swallowing food movements is a complex process, especially in the process of swallowing, the complete closure of the pharyngeal airway must be precisely coordinated to prevent food from entering the airway by mistake. In addition to the consequences of aspiration, asphyxia, aspiration pneumonia and malnutrition, swallowing disorders also cause psychosocial effects, including patients avoiding meals, showing anxiety, panic, pessimism and disappointment during mealtime, resulting in low self-confidence in survival. The incidence of abnormal pharyngeal function and structural lesions due to ageing and disease is increasing. Therefore, pharyngeal swallowing abnormalities are the most common. I. Etiology 1, neuromuscular system diseases: swallowing is a series of reflex processes involving neuromuscular, central nervous system lesions, such as stroke, cranial trauma, medulla oblongata paralysis, resulting in uncoordinated airway closure during swallowing, causing misaspiration. Peripheral nervous system lesions and myasthenia gravis can also cause pharyngeal muscle contraction weakness, causing abnormal swallowing function. 2, head and neck tumors: tumors often block the swallowing channel, causing mechanical swallowing disorders. The surgery of oral cavity and head and neck often destroy the anatomical structure of normal swallowing and cause dynamic swallowing disorder. The fibrosis of neck muscles after radiotherapy of head and neck tumor leads to poor laryngeal lift function, and the epiglottis cannot cover the vocal folds in time, and the opening of esophageal entrance is affected, which greatly affects the swallowing function. 3.Difficulty in opening the esophageal entrance: pharyngoesophageal diverticulum, cricopharyngeal muscle dystonia, fibrosis in the neck after radiotherapy, and spasm of cricopharyngeal muscle caused by central lesions all cause the esophageal entrance not to open normally during swallowing, resulting in swallowing difficulties and misaspiration. 4. Other: other disorders of the pharynx, such as peri-tonsil abscess, posterior pharyngeal wall abscess, pharynx, laryngeal nodules, pharyngeal trauma and other disorders. Second, the clinical assessment methods for the diagnosis of obvious swallowing disorders is not difficult, but for the diagnosis of symptoms or early swallowing abnormalities is particularly important, early diagnosis, early treatment can prevent the occurrence of serious complications of swallowing disorders. 1.Repeated saliva swallowing test The patient takes a sitting position, the examiner puts his finger at the patient’s laryngeal node and hyoid bone, let him swallow as fast as possible repeatedly, feel the hyoid bone move with swallowing, cross the finger, move forward and upward and then reset, confirm this up and down movement, the moment of descent is swallowing completion, observe the number of times the patient swallows and the magnitude of laryngeal lift in 30 seconds, swallowing less than 3 times in 30 seconds is considered abnormal swallowing function. 2.Wakita drinking test Observe the time required for the patient to swallow 30ml of warm boiled water, i.e., the time from the mouth containing water to the completion of swallowing, using the laryngeal movement as the standard, conduct one test, calculate the shortest time and record the choking and coughing situation. Evaluation criteria: Grade 1: water can be swallowed smoothly once within 5 s; Grade 2: water swallowed more than twice within 5 s without choking; Grade 3: swallowed once within 5 s, but with choking; Grade 4: swallowed more than twice within 5-10 s with choking; Grade 5: water cannot be swallowed completely within 10 s with frequent choking. Grade 1 is normal, Grade 2 is suspected abnormal, and Grade 3-5 is abnormal. 3.Transeptal feeding function scale The patient’s swallowing function was indirectly determined according to the patient’s transeptal feeding condition, which was divided into 7 levels. level 1: completely unable to eat through the mouth; level 2: dependent on the nasal feeding tube, can eat a very small amount of food through the mouth; level 3: can eat a single food through the mouth, but needs to be supplemented by the nasal feeding tube; level 4: completely eat through the mouth, but can only eat a single food; level 5: completely eat through the mouth, food can be varied, such as cut into small pieces and need special preparation. Level 6: complete oral feeding, food does not require special preparation, but some special food cannot be eaten; Level 7: complete oral feeding without any restriction. levels 6 and 7 are normal, levels 1 to 5 are abnormal. Third, auxiliary examination 1, pharyngeal dynamic imaging examination: through video acquisition of the swallowing process under X-ray, processed by special software, dynamic analysis of the swallowing function, not only can clarify the occurrence and extent of misaspiration, but also effectively observe the distance of hyoid bone movement during swallowing, the time of food passing through the pharyngeal cavity, the contraction rate of the pharyngeal cavity and the maximum opening of the esophageal entrance. This method can observe the whole process of swallowing and can detect subtle changes in swallowing function at an early stage, which is an objective method of swallowing function examination that is currently accepted at home and abroad. The disadvantage is that patients need to go to radiology department for examination, and it is not suitable for patients who have serious misaspiration by clinical assessment. 2.Electrolaryngoscopic swallowing function examination: The evaluation of pharyngeal motor function before and after swallowing during the pharyngeal period is used to assess the food delivery during swallowing. Under the electronic laryngoscope, the patient is allowed to swallow edible pigment-stained liquid and food of different concentrations to observe the speed of swallow initiation, the residual situation in the pear-shaped fossa after swallowing, and the presence and extent of misaspiration. The advantage is that the operation is simple and the examination can be completed at the bedside. The disadvantage is that the whole process of swallowing cannot be observed, only the pharynx before and after swallowing is observed, and the swallowing is judged by the residual situation of food in the pharynx before and after swallowing and misaspiration. Fourth, treatment methods 1, rehabilitation functional exercise: mainly refers to some compensatory methods and muscle exercise methods, through targeted training exercises for targeted training, which helps the functional rehabilitation of swallowing disorders caused by central neurological and muscular lesions. 2.Electrical stimulation therapy: Activate the muscles related to swallowing by stimulating the intact peripheral motor nerves. The main therapeutic goal is to strengthen weak muscles, help restore motor control and prevent muscle disuse atrophy. It can be used for muscle lesions or muscle disuse neuropathy. Low frequency electrical stimulators are now commercially available for the rehabilitation of swallowing disorders. 3.Esophageal inlet balloon dilatation: Balloon dilatation of the esophageal inlet via fiberoptic laryngoscope or electronic laryngoscope can enlarge the esophageal inlet, reduce the resting pressure of the esophageal inlet, reduce the strength of the pharyngeal muscle contraction during swallowing, and facilitate the passage of the food mass. It is suitable for patients with hypocontractile pharyngeal muscles due to neurological and muscular pathologies and for patients with cricopharyngeal muscle dystonia. Also its treatment predicts the outcome of cricopharyngeal myotomy. Patients usually need repeated expansion treatment. 4.Circumpharyngeal myotomy: Transoral endoscopic CO2 laser-assisted cricopharyngeal myotomy can reduce the resting pressure of the esophageal inlet, and the indications are the same as those for esophageal inlet balloon dilation, and the treatment effect is permanent. 5.Surgery for severe misaspiration: severe misaspiration, leading to aspiration pneumonia and malnutrition, can be fatal to patients. Nasal feeding diet or gastrostomy can improve the nutritional status of the patient, but the patient loses the basic ability to eat through the mouth and the quality of life is greatly reduced. The current surgical treatment options are vocal occlusion, total laryngectomy, and laryngotracheal dissection. The possibility of food aspiration is avoided, but the patient loses the ability to articulate.