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Difficulty in swallowing (dysphagia) is common among all age groupsespecially the elderlyThe term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomachThis may be caused by many factorsmost of which are temporary and not threateningDifficulties in swallowing rarely represent a more serious diseasesuch as a tumor or a progressive neurological disorderWhen the difficulty does not clear up by itself in a short period of timeyou should see one of our ENT physicians.

How do we swallow?

People normally swallow hundreds of times a day to eat solidsdrink liquidsand swallow the normal saliva and mucus that the body produces.

The process of swallowing has four related stages:

  • The first stage is the oral preparation stagewhere food or liquid is manipulated and chewed in preparation for swallowing.
  • The second stage is the oral stagewhere the tongue propels the food or liquid to the back of the mouthstarting the swallowing response.
  • The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynxthe region of the throat which connects the mouth with the esophagusthen into the esophagus or swallowing tube.
  • In the finalesophageal stagethe food or liquid passes through the esophagus into the stomach.

Although the first and second stages have some voluntary controlstages three and four occur involuntarilywithout conscious input.

Swallowing disorder symptoms

Symptoms of swallowing disorders may include:

  • Drooling.
  • A feeling that food or liquid is sticking in the throat.
  • Discomfort in the throat or chest (when gastro esophageal reflux is present).
  • A sensation of a foreign body or “lump” in the throat.
  • Weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing.
  • Coughing or choking caused by bits of foodliquidor saliva not passing easily during swallowing and being sucked into the lungs.
  • Voice change.

How are swallowing disorders diagnosed?

When dysphagia is persistent and the cause is not apparentour ENT physician will discuss the history of your problem and examine your mouth and throatThis may be done with the aid of mirrorsSometimes a small tube (flexible laryngoscope) is placed through the nose and the patient is then given food to eat while the scope is in place in the throatThese procedures provide visualization of the back of the tonguethroatand larynx (voice box)These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing)If necessaryan examination of the esophagusnamed TransNasal Esophagoscopy (TNE)may be carried out by one of our ENT doctorsIf you experience difficulty swallowingit is important to seek treatment to avoid malnutrition and dehydration.

Swallowing disorder treatment

Many of these disorders can be treated with medicationDrugs that slow stomach acid productionmuscle relaxantsand antacids are a few of the many medicines availableTreatment is tailored to the particular cause of the swallowing disorder.

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

  • Eat a bland diet with smallermore frequent meals.
  • Eliminate tobaccoalcoholand caffeine.
  • Reduce weight and stress.
  • Avoid food within two hours of bedtime.
  • Elevate the head of the bed at night.

If these don’t helpantacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapyA speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflexPatients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselvesAn occupational therapist or a speech language pathologist can aid the patient and family in feeding techniquesThese techniques make the patient as independent as possibleA dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Once the cause is determinedswallowing disorders may be treated with:

  • Medication
  • Swallowing therapy
  • Surgery

Surgery is used to treat certain problemsIf a narrowing exists in the throat or esophagusthe area may need to be stretched or dilatedIf a muscle is too tightit may need to be dilated or released surgicallyThis procedure is called a myotomy and can be performed by one of our ENT physicians.

Many diseases contribute to swallowing disordersIf you have a persistent problem swallowingplease make an appointment with one of our ENT doctors.

Swallowing disorder causes

Any interruption in the swallowing process can cause difficultiesEating slowly and chewing thoroughly can help reduce problems with swallowingHoweverdifficulties may be due to a range of other causesincluding something as simple as poor teethill fitting denturesor a common coldOne of the most common causes of dysphagia is gastro esophageal refluxThis occurs when stomach acid moves up the esophagus to the pharynxcausing discomfortOther causes may include: hypertensiondiabetesthyroid diseasestrokeprogressive neurologic disorderthe presence of a tracheotomy tubea paralyzed or unmoving vocal corda tumor in the mouththroator esophagusor surgery in the headneckor esophageal areas.

Swallowing difficulty can also be connected to some medications including:

  • Nitrates.
  • Anticholinergic agents found in certain anti-depressants and allergy medications.
  • Calcium tablets.
  • Calcium channel blockers.
  • Aspirin.
  • Iron tablets.
  • Vitamin C.
  • Antipsychotic.
  • Tetracycline (used to treat acne).
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