Swallowing Disorders

Swallowing is a life-sustaining process that, thankfully, most of us don’t have to give much thought . It happens so automatically, we rarely have to the think about it! If you did, you’d realize the multitude of steps that go into swallowing and how a small abnormality can derail the whole process. The medical term for difficulty swallowing is dysphagia and it can be a symptom and result of numerous medical disorders.

The swallowing process occurs in three phases. Problems can occur in one or all of the phases.

  • Phase 1 - The Oral Phase: During this phase, sucking, chewing, and moving food or liquid from the mouth down into the throat occurs.
  • Phase 2 - The Pharyngeal Phase: The actual act of swallowing and moving food down the throat into the esophagus (the feeding tube that leads to the stomach) begins in this phase. The airway needs to close of off so food doesn’t cause choking and coughing.
  • Phase 3 - The Esophageal Phase: Here, the esophagus moves in such a way to push the food down into the stomach.

Symptoms of Swallowing Disorders
Signs and symptoms of swallowing disorders may be subtle or extremely obvious. They can occur on a daily basis or depend greatly on what is being eaten and in what setting. When the nerves and muscles do not communicate properly, food and liquid can spill into the voice box (larynx) and breathing passages (trachea and bronchi), causing hoarseness, throat clearing, coughing and many other problems.

Some common symptoms that may indicate a swallow disorder is occuring include:

  • Coughing that occurs around eating and drinking
  • Regurgitation
  • Pain in the chest after swallowing
  • The need for a conscious effort to swallow
  • Excessive drooling after eating
  • Unintentional weight loss

Swallowing disorders can lead to a variety of unpleasant results and serious medical conditions including pneumonia, malnutrition, poor dentition, and dehydration. Those with swallowing disorders are often embarrassed and are prone to avoid eating in public, taking a huge toll on social and emotional well-being.

Causes of Swallowing Disorders
Many conditions can cause or contribute to swallowing problems. Certain medications can also cause dry mouth, making it difficult to chew and swallow.

Factors that can contribute to dysphagia include:

  • Inflammation or ulceration in the esophagus
  • Age
  • Head or neck injury
  • Oral or cervical surgery
  • Poor dentition or dentures that do not fit well
  • Cancer in the esophagus, mouth or throat
  • Stress
  • Gastroesophageal reflux disease (GERD)
  • Traumatic brain injury
  • Neurological disorders such as stroke, Parkinson’s, multiple sclerosis, ALS, cerebral palsy and Alzheimer’s

Diagnosing Swallowing Disorders
When dysphagia is persistent and the cause is not apparent, the otolaryngologist, or head and neck surgeon, will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides vision of the back of the tongue, throat, and larynx (voice box). If necessary, an examination of the esophagus, stomach, and upper small intestine (duodenum) may be carried out by an otolaryngologist or a gastroenterologist. These specialists may recommend X-rays of the swallowing mechanism, called a barium swallow, or upper GI, which is done by a radiologist.

If special problems exist, a speech pathologist may consult with the radiologist regarding a modified barium swallow or videofluoroscopy. These help to identify all four stages of the swallowing process. Using different consistencies of food and liquid, and having the patient swallow in various positions, a speech pathologist will test the ability to swallow. An exam by a neurologist may be necessary if the swallowing disorder stems from the nervous system, perhaps due to stroke or other neurological disorders.

Treatment of Swallowing Disorders
The treatment you need for your swallowing disorder will depend on the cause of your swallowing difficulties. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder. Often, therapy that retrains the muscles of the neck and throat is necessary with the help of a speech pathologist. Other strategies that help make swallowing easier include:

  • Eating slowly
  • Eating softer foods
  • Drinking thicker liquids
  • Sitting upright when eating

If you think you or someone you love may be suffering from a swallowing disorder, contact our office today for a thorough evaluation and treatment plan.

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