Swallowing Disorders

Dysphagia or difficulty in swallowing is common in all age groups, but especially the elderly. The term Dysphagia refers to the feeling of difficulty passing food or liquid from mouth to stomach. This can be caused by many different factors, most of which are temporary. Difficulties in swallowing can represent a more serious disease, such as a tumor or a progressive neurological disorder. If the difficulty does not clear up in a short amount of time, you should see an otolaryngologist.

What happens when we swallow?

People usually swallow hundreds of times a day. This happens when eating, drinking, and swallowing saliva and mucus.

The 4 stages of swallowing:

  • The oral preparation stage is the first stage, where food or liquid is chewed in preparation for swallowing.
  • The second stage is the oral stage, where the tongue pushes the food or liquid to the back of the mouth which triggers the swallowing response.
  • The pharyngeal stage is the third stage, which begins as food or liquid is passed through the pharynx, (the region of the throat which connects the mouth with the esophagus) then into the esophagus or swallowing tube.
  • Finally, in the esophageal stage the food or liquid passes from the esophagus into the stomach.

Although the first and second stages have some voluntary control, stages three and four are involuntarily.

What are the symptoms of swallowing disorders?

Symptoms of swallowing disorders may include:

  • Drooling
  • Feeling like food or liquid is stuck in the throat
  • Throat or chest discomfort (when gastro esophageal reflux is present)
  • A sensation of a “lump” in the throat
  • Weight loss or malnutrition due to prolonged problems with swallowing
  • Coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing,
  • Food or debris being sucked into the lungs
  • Voice issues

How are swallowing disorders diagnosed?

When swallowing issues are persistent and the cause is not apparent, the otolaryngologist will discuss the history of the problem and perform an examine of the mouth and throat.

This may be done with the aid of mirrors. Sometimes a flexible laryngoscope or small tube is placed through the nose and the patient is then given food to eat while the scope is in place in the throat.

These procedures provide visualization of the back of the tongue, throat, and larynx or voice box. These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing).

Sometimes an examination of the esophagus, called Trans Nasal Esophagoscopy (TNE), may be carried out by the otolaryngologist.

If you have trouble swallowing, it is important to seek treatment to avoid malnutrition and dehydration.

How are swallowing disorders treated?

Many swallowing disorders can be treated with medication. These drugs include slowing stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatments are specific to the cause of the swallowing disorder.

Gastro esophageal reflux can often be treated by changing eating and living habits:

  • A bland diet with small, more frequent meals.
  • Eliminate cigarettes, vapes, alcohol and caffeine.
  • Reducing weight and stress.
  • Avoiding food close to bedtime.
  • Elevating the head at night.

If these don’t help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders are helped with swallowing therapy. A speech pathologist can provide special exercises to coordinate the swallowing muscles or stimulating the nerves that trigger the swallow reflex. There are also ways to place food in the mouth or position the body and head to help swallowing to occur.

Occupational therapist or a speech language pathologist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

How are swallowing disorders treated?

Once we determine the cause, swallowing disorders may be treated with:

  • medication
  • swallowing therapy
  • surgery

Surgery can be used to treat certain swallowing disorders. If there is a narrowing in the throat, the area may need to be stretched. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist or head and neck surgeon.

What are the common causes of swallowing disorders?

When eating slowly and chewing thoroughly does not reduce problems with swallowing, then difficulties may be due to a range of other causes. These causes can include bad teeth, dentures that don’t fit, or even a common cold.

One of the most common causes of dysphagia is gastro esophageal reflux. This happens when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: hypertension; diabetes; thyroid disease; stroke; progressive neurologic disorder; a paralyzed vocal cord; or a tumor in the mouth, throat, or esophagus.

Swallowing difficulty can also be connected to some medications including:

  • Certain anti-depressants and allergy medications
  • Calcium tablets or calcium channel blockers
  • Aspirin
  • Iron tablets
  • Vitamin C
  • Antipsychotic medications
  • Nitrates
  • Tetracycline (used to treat acne)

Many diseases contribute to swallowing disorders. If there is a persistent problem swallowing, call (719) 867-7800 to make an appointment today.

 

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