• Users Online: 253
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 33  |  Issue : 1  |  Page : 52-54

A case report on the management of phagophobia


1 Phoniatrics Unit, Department of Speech and Audiology, Ministry of Health, Kuwait City, Kuwait
2 Department of Audiology, National Hearing Care, Australia

Date of Submission24-Nov-2017
Date of Decision17-Feb-2018
Date of Acceptance27-Feb-2019
Date of Web Publication28-Jun-2019

Correspondence Address:
Tina Merin Job
2 Valencia Boulevard, Doreen, VIC 3754
Australia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisha.JISHA_42_17

Rights and Permissions
  Abstract 


Phagophobia is the fear of swallowing. It often causes dysphagia without an organic cause. The incidence of phagophobia is sparse in literature. The client is a 29-year-old female who presented with dysphagia. Following the change in her lifestyle and increased stress levels, she developed faulty eating habits and soon presented with inability to swallow food and fear of food getting stuck in her throat. This case study aims to highlight some of the management strategies that were most effective in the treatment of our client's phagophobia. Special emphasis is given to the role of visual feedback using fiberoptic endoscopic evaluation of swallow in the treatment of phagophobia in addition to educating the client about the physiology of swallowing and use of other cognitive behavioral techniques.

Keywords: Fear of swallow, phagophobia, visual feedback


How to cite this article:
Al-Haifi AK, Job TM. A case report on the management of phagophobia. J Indian Speech Language Hearing Assoc 2019;33:52-4

How to cite this URL:
Al-Haifi AK, Job TM. A case report on the management of phagophobia. J Indian Speech Language Hearing Assoc [serial online] 2019 [cited 2019 Oct 15];33:52-4. Available from: http://www.jisha.org/text.asp?2019/33/1/52/261761




  Introduction Top


The term “phagophobia” is used to describe the fear of swallowing.[1] Individuals with phagophobia usually present with complaints of swallowing in the absence of an organic cause. The Diagnostic and Statistical Manual of Mental Disorders-IV classifies phagophobia as a specific phobia in the residual category.[2]

Although the incidence of phagophobia was first reported in the 1970s,[3] the body of literature on phagophobia and swallowing fear still remains very limited.[4]

Most of the previously reported studies on phagophobia suggest use of cognitive behavioral approaches to manage phagophobia.[2],[3] However, some clients may require a combination of treatment approaches for effective management.

The present study describes the case of a female with phagophobia who was successfully managed when provided with combination of intervention involving visual feedback of the swallowing process, counseling, and swallowing retraining.


  Case Report Top


The client is a 29-year-old female who presented with symptoms of food getting stuck in her throat and fear of swallow. She had a history of gastroesophageal reflux disorder two years ago and was advised antireflux medication by her gastroenterologist, which she completed.

She also had an episode of postpartum depression one year ago, for which she visited the psychiatrist and was recommended antidepressants (Pristiq). Her condition is stable at present.

Our client is a school teacher who recently enrolled in a new business venture. To cope with the extra working hours and stress levels, she adopted faulty eating habits during which she reduced her intake of food from three meals a day of both solids and liquids to one solid meal and liquids per day.

She developed phagophobia shortly after this, wherein she felt that the food would get stuck in her throat and that she would choke to death.

An oral motor examination, bedside assessment of swallow, stroboscopy, and fiberoptic endoscopic evaluation of swallow (FEES) were carried out to rule out any organic cause of the symptoms reported.

The oromotor examination revealed normal strength and range of motion of the articulators. Beside assessment of swallow was used as a perceptual tool to assess client's swallow. The client's cognitive and neurological status was found to be alert and watchful. Feeding modality was oral, and client preferred liquids and semisolids. Reflexes including bite, cough, and suck reflex were tested and found to be normal. The 3-ounce water swallow test[5] was carried out which client completed with ease.

On examination of the larynx using stroboscopy, the client was found to have bilateral mobile vocal cords, with adequate glottal competence.

FEES was carried out using thin and thick liquid, puree, and solid food consistencies. We found the client was a bit hesitant in the oral preparatory phase of swallow. During bolus intake, she preferred very small quantity of food and preferred to chew it for a while before positioning it. During the oral phase, it was observed that client preferred liquid intake following intake of a solid bolus. Food was minimally colored to assess secretions, and residue in the hypopharynx after the swallow was completed. It was observed that client did not require multiple swallows to clear the bolus, and there was no food residue below the vocal folds after the swallow. The client did not have any episode of aspiration or penetration before or after the swallow.

Esophageal dysphagia was ruled out after consultation with the client's GI specialist and also as the client did not report of symptoms of pain or heart burn associated with swallowing.

The results of the investigations revealed that the client had no organic cause for the symptoms reported and was therefore diagnosed with phagophobia by our medical team comprising a phoniatrist, speech language pathologist, and psychologist.

The treatment plan consisted of client education and behavioral management for a placebo effect. Behavioral management included visual feedback of client's swallow and dysphagia management techniques. Client education consisted of providing detailed explanation regarding the anatomy and physiology of the swallowing process. Behavioral management involved counseling and reassurance of the client's fear and phobia as well as giving her a visual feedback of her own swallowing video. This was accomplished by replaying the video recording of the FEES to the client, wherein she was able to visualize the passage of the food bolus pre- and post-swallow. She was thus reassured that no food residue was stuck at the base of her tongue, posterior, lateral pharyngeal walls, and hypopharynx post swallow. The dysphagia management techniques were used as a placebo effect as well as to educate the client about the correct postures and exercises for a safe swallow. Client was shown how to maintain an upright-seated posture and use regulated breathing pattern before and after swallow. Swallowing maneuvers such as chin tuck and effortful swallow were demonstrated and the rationales explained so that client could use it if she felt she was having an episode of choking. The food consistencies were gradually changed from liquids to semisolids to solids, and the frequency of intake was gradually improved from one meal a day to three meals a day.


  Discussion Top


Phagophobia is a relatively new entity,[1] and the numbers of reported incidences in literature are few.[2] Hence, there are no fixed management strategies to manage such clients. However, most case reports on phagophobia recommend the use of behavioral strategies as a part of the management process.[2],[3]

We would like to emphasize on the importance of providing a visual feedback in the effective management of clients with phagophobia. In a study by Thottam Prasad et al.,[6] it was seen that use of FEES was effective in managing children with phagophobia. Similarly, when our client was given a visual feedback of her own swallow, she was more reassured that the food being swallowed was entering her esophagus and not her trachea and she was also able to visualize that no residue was remaining post swallow. Therefore, visual feedback seems to be an important tool in dealing with clients with phagophobia.

Along with this, the use of dysphagia management techniques such as posture monitoring, relaxation of the muscles before swallow such as breathing techniques, changing the type of bolus, and slowly increasing the amount of bolus intake, seems to have created a stronger placebo effect for our client. It is also essential that clinicians gain the client's trust and monitor his/her meal times until he/she is able to take adequate amounts of food without fear of swallow.

Our client attended four sessions of therapy (one session per week), and by the end of these sessions, she was found to have reduced fear of food getting stuck, intake all types of food consistencies, and have three meals per day.

Limitations

Our client did not attend psychological counseling sessions due to financial reasons which we believe is one of the drawbacks of this study, but our team psychologist was involved in the diagnosis and formulation of treatment plan for this client.

Acknowledgment

We would like to acknowledge the participant for her cooperation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shapiro J, Franko DL, Gagne A. Phagophobia: A form of psychogenic dysphagia. A new entity. Ann Otol Rhinol Laryngol 1997;106:286-90.  Back to cited text no. 1
    
2.
Suraweera C, Hanwella R, de Silva V. Phagophobia: A case report. BMC Res Notes 2014;7:574.  Back to cited text no. 2
    
3.
Kaplan PR, Evans IM. A case of functional dysphagia treated on the model of fear of fear. J Behav Ther Exp Psychiatry 1978;9:71-2.  Back to cited text no. 3
    
4.
Baijens LW, Koetsenruijter K, Pilz W. Diagnosis and treatment of phagophobia: A review. Dysphagia 2013;28:260-70.  Back to cited text no. 4
    
5.
Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia 2008;23:244-50.  Back to cited text no. 5
    
6.
Thottam PJ, Silva RC, McLevy JD, Simons JP, Mehta DK. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in the management of psychogenic dysphagia in children. Int J Pediatr Otorhinolaryngol 2015;79:108-10.  Back to cited text no. 6
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References

 Article Access Statistics
    Viewed253    
    Printed27    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]