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Swallowing Disorders: Causes, Diagnosis, and Treatment

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Swallowing Disorders: Causes, Diagnosis, and Treatment

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Swallowing disorders present with difficulty swallowing or pain during swallowing. The following article explains swallowing disorders in detail.

Medically reviewed by

Dr. Sneha Kannan

Published At January 25, 2018
Reviewed AtJuly 14, 2023

Introduction:

Swallowing refers to muscular movements controlling the mouth, the back of the throat (pharynx), and the food tube (esophagus). Swallowing occurs involuntarily without even thinking about it. Yet it is a complex and vital function, as it is very important for eating and social interaction. Swallowing happens in three phases.

  • Oral (mouth): Chewing the food along with saliva.

  • Pharyngeal (throat): Pushing the food from the mouth to the esophagus.

  • Esophageal (food pipe): Sequential passing of food into the stomach without backflow.

What Is Meant by Swallowing Difficulty?

The medical term used for difficulty in swallowing is dysphagia. A patient may also complain of trouble in moving food through the mouth, pharynx, and food pipe. Sometimes, the patient might pinpoint the level of sticking of food. If it is said to be above the suprasternal notch, then the site of obstruction is the oropharynx. Pointing to the level of the chest might indicate food pipe obstruction. The condition is more common in the elderly.

What Are the Types of Swallowing Disorders?

There are two terms that explain the problems with swallowing,

Dysphagia: A sense of discomfort with choking or coughing during swallowing.

Odynophagia: Pain during swallowing.

Often both the conditions are presented together and addressed as dysphagia.

What Are the Symptoms of Swallowing Disorder?

Associated symptoms relevant to dysphagia are:

  • Pain.

  • Weight loss.

  • Presence of a mass in the neck.

  • Change in voice.

  • Regurgitation of foods.

  • Aspiration of food.

What Are the Causes of Swallowing Disorders?

Dysphagia can be due to mechanical reasons or due to abnormalities in the muscles controlling the action of swallowing.

1. Mechanical Causes:

  • Obstruction to the movement of the bolus of food (chewed food with saliva).

  • Foreign bodies.

  • Tumors.

  • Webs or rings in the food pipe.

  • Narrowing of the passage in the food pipe following cancerous growth or due to ingestion of acids or alkalis.

  • Sometimes compression of the food pipe can occur from outside as in cervical spondylitis, a thyroid mass, or a mass in the chest.

2. Abnormalities of Muscles Controlling Swallowing Can Lead To Trouble Swallowing:

How Swallowing Disorders Are Diagnosed?

Diagnosis of swallowing problems is suspected from history. Difficulty in swallowing solids can indicate mechanical while liquid can indicate neurological disorders.

Initial consultation with a family doctor and referral to an ENT (ear, nose, throat) specialist might be needed. The ENT doctor starts with the examination of the inside of the throat and then proceeds with an indirect laryngoscopic examination of the throat. This test involves placing a mirror inside the mouth after pulling your tongue and holding it with cotton. The patient is asked to breathe/say 'Aaa' or 'Eee' for visualization of the food pipe area. This test usually is well tolerated by most patients after proper explanation and reassurance before the test.

Investigations relevant to dysphagia are barium swallow (a type of X-ray test), and endoscopic examination of the food pipe if mechanical causes are suspected.

Endoscopy:

An endoscopy is a procedure to visualize the upper digestive tract using a tiny camera with a light inserted through the mouth into the esophagus.

In endoscopy,

  • Sedation or anesthesia is given.

  • The endoscope is inserted.

  • The physician may look for any abnormalities in the pharynx (back throat), esophagus (food pipe), and stomach.

  • Ulcers, narrowing of the esophageal opening, and tumors can be evaluated in endoscopy.

  • A piece of the diseased tissue can be removed (biopsy) for further microscopical evaluation.

Barium Esophagram:

Swallowing disorders can be assessed well in barium esophagram. The structure and the function of the gastrointestinal tract can be better viewed. Barium is a radiocontrast material used to highlight the body parts in the radiograph.

In barium esophagram,

  • The patient under investigation is given liquid barium to swallow as a whole and X-rays are passed to get the images.

  • Barium washes and covers the lining of the food tract and makes it clear for visualization.

  • The sequence of X-rays can be performed to assess the swallowing pattern.

Esophageal Manometry:

Pressure is usually generated inside the esophagus during swallowing. The changes in the pressure can be measured in esophageal manometry.

In esophageal manometry,

  • A tube is inserted through the mouth or nose.

  • The tube has multiple attached pressure sensors that record the muscle activity during swallowing.

  • Water or food can be given to trigger the action and the real-time movement can be measured.

  • Esophageal manometry gives information about the ability of the esophageal muscles and the sphincter that controls the bolus movement.

pH Testing:

The acidic pH in the lower esophagus is checked to evaluate the acid reflux symptoms like heartburn and irritation during swallowing. A ph sensor chip is introduced into the digestive tract and left in place for two days, that records the data and transmits the information.

How Swallowing Disorders Are Treated?

The treatment of swallowing problems depends on the cause. Sometimes, they go away on their own, while at other times, treatment by a specialist may be necessary. Meanwhile, it is good to follow some lifestyle modifications like eating soft food, chewing very little food at a time, taking syrup or crushed forms of medication, etc.

The treatment option includes,

  • Medication to treat muscular and neurological dysfunction.

  • Artificial saliva can be used to prevent dryness.

  • Dilation to broaden the constricted esophagus.

  • Stent placement in the esophagus to retain the dilation.

  • Surgery may be needed to remove tumors.

Conclusion:

The swallowing disorder can deprive the person of getting proper nutrition and energy. The patient should understand the underlying cause of swallowing problems and try to avoid the triggering factors. Lifestyle modifications and exercises can help in most cases. When swallowing difficulties are not addressed properly, it may lead to complications like severe cough, dehydration, malnutrition, and pulmonary complications.

Frequently Asked Questions

1.

What Is the Most Common Cause That Leads to Swallowing Disorders?

Common causes of swallowing disorders are traumatic brain injury, stroke, and Parkinson's disease. Difficulty in swallowing occurs due to blockage of the esophagus and poor function of muscles and nerves that control swallowing.

2.

How to Treat Swallowing Disorders?

Medications can be used to treat neurological and muscular dysfunction. Artificial saliva can be used to prevent dryness. Dilation can be used to broaden the constricted esophagus. Stent placement in the esophagus can be done to retain dilation.

3.

Who Tests for Problems Related to Swallowing?

The tests for problems related to swallowing are usually performed by ENT (ear, nose, throat) specialists. The ENT doctor does the examination of the inside of the throat and then proceeds with an indirect laryngoscopic examination of the throat. The test involves placing a mirror inside the mouth after pulling the tongue and holding it with the cotton.

4.

What Part of Your Brain Helps in Controlling Swallowing?

The medulla oblongata is the part of the brain that helps control swallowing. The swallowing phases are controlled by a central pattern generator located in the medulla oblongata. The pharyngeal, oral, and esophageal phases of swallowing are independent of each other.

5.

What Is Meant by Neurological Swallowing Disorders?

Neurological swallowing disorder is trouble in swallowing with a number of neurological disorders. The condition can occur at any stage of the swallowing process as liquid and food move from the mouth through the esophagus into the stomach. The prognosis of neurological swallowing disorder depends upon the type of swallowing problem.

6.

Can Trouble Swallowing Get Cured?

Trouble swallowing can improve with treatment, but the cure is not always possible. Treatments for trouble swallowing involve language and speech treatment therapy. Changing the consistency of liquid and food to make them safer to swallow.

7.

Can Anxiety Lead To Swallowing Problems?

Anxiety or stress can cause some people to feel something stuck or tight in their throat. This type of sensation is called globus sensation. It is not related to an eating disorder. Anxiety can further cause the throat muscles to constrict, which feels like a lump in the throat.

8.

Can Endoscopy Helps in the Detection of Swallowing Problems?

Endoscopy is a procedure used to visualize the upper digestive tract using a light-inserted camera through the mouth in the esophagus. It helps in detecting swallowing problems suspected by the patient. A piece of diseased tissue can be removed for further microscopic examination.

9.

What Nerve Affects the Process of Swallowing?

The tenth nerve, known as the vagal nerve, provides both sensory and motor innervations to the solitary nucleus in the swallowing center. It plays an essential role in the pharyngeal phase of swallowing. Damage to the spinal cord and brain can interfere with the nerve responsible for controlling swallowing.

10.

Can Spinal Problems Lead to Difficulty in Swallowing?

Spinal cord injury can lead to difficulty in swallowing. According to some studies, degenerative changes in facet joints and cervical discs are spine disorders that can cause difficulty swallowing. It can sometimes be life-threatening too.

11.

What Cancer Leads to Difficulty in Swallowing?

Esophageal cancer usually leads to difficulty in swallowing. It feels like food stuck in the throat and can even cause choking. The symptoms of esophageal cancer worsen with time and cause pain in swallowing. It is often associated with burning or pressure in the chest.

12.

What Are the Two Different Types of Dysphagia?

Dysphagia is a sense of discomfort with choking and coughing during swallowing. The two types of dysphasia are esophageal and oesophageal dysphasia. Oropharyngeal dysphagia is associated with mouth or throat, while oesophageal dysphasia occurs in the esophagus, a tube that helps to carry food from mouth to stomach.

13.

Can Acid Reflux Lead To Difficulty Swallowing?

In acid reflux, the acids flow back into the esophagus from the stomach due to problems with esophageal sphincter muscle relaxation. The person may experience trouble or difficulty in swallowing. Medication is the first line of treatment to relieve difficulty in swallowing due to acid reflux.

14.

Are Exercises Helpful to Improve Swallowing?

Swallowing exercise can help improve the muscles' mobility, strength, and control. A speech-language pathologist may help in suggesting swallowing exercises to improve swallowing. The exercise depends upon the specific swallowing conditions.

15.

Why Does a Person Lose the Ability to Swallow?

Disorders of the esophagus, such as systemic sclerosis, cricopharyngeal spasms, and achalasia(refers to condition in which the muscles of the lower part of the esophagus fail to relax, which prevents the food from passing into the stomach), may affect the person's ability to swallow. The swallowing disorder can deprive the person of getting proper energy and nutrition. Lifestyle modification and exercise may help in most cases.
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Dr. Manu Wilfred
Dr. Manu Wilfred

Otolaryngology (E.N.T)

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