Swallowing Trouble

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short time, you should see an otolaryngologist (ENT doctor or surgeon).

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What Causes Dysphagia (Difficulty Swallowing)?

Dysphagia can occur when a problem interrupts the swallowing process. Oropharyngeal dysphagia affects the mouth and throat muscles, while esophageal dysphagia may involve narrowing, blockage, or impaired movement of the esophagus muscles. Patients may experience trouble swallowing food or feel that something is stuck in your throat.

Common causes and risk factors include poor teeth, ill-fitting dentures, acid reflux, stroke, multiple sclerosis, other neurological disorders, tumors, a tracheostomy tube, vocal cord paralysis, and previous head and neck surgery. When diagnosing dysphagia, a provider may use imaging, endoscopy, or swallowing studies. Once dysphagia diagnosed and its cause is identified, an individualized dysphagia treatment plan can begin.

How is dysphagia treated? Options for treating dysphagia may include swallowing therapy, medication, dietary changes, or procedures addressing an obstruction. Patients may be advised to eat slowly and follow specific strategies to prevent food from entering the airway. Severe swallowing difficulties may require temporary nutrition through a feeding tube.

Symptoms Of Swallowing Disorders

Symptoms of swallowing disorders may include:

• Drooling
• A feeling that food or liquid is stuck in the throat
• Discomfort in the throat or chest (when gastroesophageal 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 food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs

Who Evaluates And Treats Swallowing Disorders?

When dysphagia is persistent and the cause is not apparent, the otolaryngologist-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 the otolaryngologist or a gastroenterologist. These specialists may recommend X-rays of the swallowing mechanism, called a barium swallow or upper G-I, 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 neurologic disorders.

Possible Treatments For Swallowing Disorders

Many of these disorders can be treated with medication. 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.

Gastroesophageal reflux can often be treated by changing eating and living habits, for example:

• Eat a bland diet with smaller, more frequent meals
• Eliminate alcohol and caffeine
• Reduce weight and stress
• Avoid food within three hours of bedtime
• Elevate the head of the bed at night

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

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallowing reflex. Patients 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 themselves. An occupational therapist 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.

Once the cause is determined, swallowing disorders may be treated with:

• Medication
• Swallowing therapy
• Surgery

Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. 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-head and neck surgeon.

Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist-head and neck surgeon.

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Because ear, nose, and throat concerns are often connected, our Denver and Lone Tree specialists also evaluate and treat hoarseness treatment, tonsil and adenoid care, and vocal cord paralysis care.