Swallowing Disorders

Acid Reflux

In this condition, stomach acid will back up into the esophagous and sometimes into the larynx and pharynx. This can cause inflammation of the lining. Heartburn is common when the esophageal lining is inflamed. Other symptoms, such as a sore throat, dry cough or frequent throat clearing are common when the laryngeal mucosa is inflamed.

Trauma

Trauma that affects the brain can cause neurological problems that impair swallowing, while trauma to the neck can cause swallowing problems by changing the structure of the pharynx, larynx or esophagous

Esophageal and Pharyngeal Stenosis

This refers to narrowing of the pharynx or esophagous. This can be caused a number of conditions, including prolonged inflammation, trauma and radiation to the neck.

Zenker’s Diverticulum

The most common symptom of Zenker’s diverticulum is difficulty swallowing food. Food may actually come back up out of the mouth several minutes to even hours after eating. Patients also suffer from choking, feeling mucus collecting in the throat, hoarseness or bad breath. The symptoms can be quite embarrassing and debilitating. In patients with symptoms suggestive of Zenker’s diverticulum, a simple and safe x-ray called a barium swallow is performed.

Stroke

Dysphagia is often noted in stroke survivors. Usually, dysphagia affects the oral and/or pharyngeal phase of swallowing. The patient may cough or choke while attempting to swallow saliva, liquids or food. A phenomenon called silent aspiration also may occur, whereby saliva, food and liquids enter into the lungs without any coughing or choking. In these patients, there are no outward signs or symptoms of a swallowing problem, but the condition can potentially cause bronchitis or pneumonia. A speech-language pathologist often evaluates a patient’s ability to swallow safely, without food or liquid going into his or her airway/lungs.

Parkinson’s Disease

Many patients with Parkinson’s disease have dysphagia (difficulty swallowing) due to a loss of control of the mouth and throat muscles. This might make it difficult for the patient to chew and manage solid foods. A delay in the swallowing process in either the throat or pharynx (the digestive tube between the esophagus and mouth) might also make it difficult to swallow without coughing or choking.

Dysphagia increases the risk of aspiration (inhaling fluid or stomach contents) and pneumonia in patients with Parkinson’s disease. At times, making dietary changes and following special swallowing techniques are sufficient to improve the safety of swallowing. At other times, alternative means of providing fluids and nutrition are necessary.

Amyotrophic Lateral Sclerosis (ALS) (also known as Lou Gehrig’s Disease)

ALS is a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal column. These nerve cells control voluntary muscles, which in turn allow movement. Over a period of months or years, ALS causes muscle weakness and an inability to control muscle movement, which in turn causes swallowing problems such as dysphagia.

Diagnostic Testing and Treatment for Swallowing Disorders*

Barium Swallow

Barium Swallow is an x-ray to examine the esophagus using liquid barium. The liquid barium is a white liquid, mixed with water, which the patient drinks. Liquid barium helps the esophagus show up better on the x-ray. The Barium Swallow test will show what is causing painful or troubled swallowing to ensure proper diagnosis and treatment.

Flexible Endoscopic Evaluation of Swallowing (FEES)

A FEES evaluation helps determine why a patient is having difficulty swallowing. A thin, flexible wire is inserted through the nose to look at your throat as you swallow. The physician or speech pathologist will be able to see the base of your tongue and vocal cords to too see whether foods are passing through correctly or whether you are at risk for aspirating. Certain foods are used during a FEES with different textures and consistency, along with food dye to track. If certain foods have been causing you problems, you are asked to bring those specific foods to the evaluation.

Transnasal Esphagoscopy

The transnasal esphagoscopy is a thin, flexible wire with a miniature digital camera at the end of the tip that is inserted through the nasal cavity and down the throat to capture your swallowing techniques. The transnasal esphagoscopy requires no sedation or additional medications. Like the FEES and Barium Swallow, this test captures your swallowing habits. However, it is less invasive and requires no medication or hospital stay.

Medications

Many swallowing disorders can be treated with medication. Drugs that slow stomach acid production (proton pump inhibitors), muscle relaxants, and antacids are a few of the many medicines available. Treatment is customized to the particular cause of the swallowing disorder.

Dietary Therapy

Patients suffering from swallowing disorders can also benefit from dietary therapy. Changes include: adopting a bland diet with smaller, more frequent meals; eliminating alcohol and caffeine to reduce weight and stress; avoiding meals or snacks within three hours of bedtime; and/or elevating the head of the bed while sleeping. Taking antacids between meals and at bedtime may also provide relief if the changes listed above are unsuccessful.

Direct Swallowing Therapy

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 swallow 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.

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 even released surgically. This procedure is called a myotomy and is preformed by an otolaryngologist-head and neck surgeon.

*Content provided by the American Academy of Otolaryngology-Head & Neck Surgery

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