Difficulty in Swallowing

Dysphagia can occur to anybody of any age group. Difficulty in swallowing is known as dysphagia in medical parlance. Swallowing seems very simple but, it’s actually a very complicated process in our body. It’s controlled by many muscles and nerves, of mouth, throat and food pipe. Finally, our brain further controls these nerves and muscles. So swallowing difficulty can occur, if there is any problem in mouth, oral cavity, pharynx (the throat), esophagus (the food pipe) or brain. This problem is more common as we age.

DIFFICULTIES ASSOCIATED

Swallowing difficulty means there is an increased time and effort in moving the food from the mouth into the stomach. It is often accompanied by choking sensation or pain, bringing enormous discomfort to the sufferer. Based on my practice, our patients complain of the following problems in addition to swallowing difficulty-

1. Pain while swallowing
2. Cough and aspiration while swallowing
3. Drooling of saliva
4. Gagging
5. Choking feeling
6. Weak voice
7. Weight loss
8. Loss of appetite
9. Recurrent cheat infections (pneumonia)
10. Liquids or food come into the throat after you swallow (regurgitation)

BROAD TYPES OF DYSPHAGIA

Dysphagia is categorized into two types broadly. In the first there is a problem with the muscles and nerves controlling the process of swallowing. In the second there is some physical block in the movement of food from the mouth to stomach.

There are at least a thousand causes which produce the difficulty. We have enlisted the most common among these for your quick reading.

CAUSES

The list contains various causes arranged as per the location, from brain to the junction of food pipe with stomach.

1. Brain – Any nerve related disease like Parkinsonism, cerebral palsy, multiple sclerosis or brain tumor
2. Mouth (Oral cavity) – Ulcer, jaw joint infection or dislocation, injury to the area, nerve weakness of roof of the mouth, side-effects of chemotherapy or radiotherapy, infection or stone in glands that produce saliva, cancer or growth inside the mouth
3. Throat (Pharynx) – Tonsil infection, pharyngitis, pus collection, foreign body lodged inside accidentally, injury to the throat as in road traffic accidents, after effects of surgery, poisoning and throat cancer.
4. Food pipe (Esophagus) – Infection, injury, motility disorder, foreign body lodged inside the food pipe, thickening inside the pipe, growth or cancer and reflux.
5. Areas nearby – Any growth or tumor of the surrounding area like lungs, heart, thyroid or trachea can enlarge in size and compress the food pipe. This makes swallowing difficult.

CONDITIONS ASSOCIATED – should I worry?

Dysphagia is a common problem. Most amongst us would have had at least one episode of it in our lives. But, should we worry if we have another episode? Though most of the causes of dysphagia are related to acidity, infection and other milder reasons, the difficulty may be a presenting feature of cancer.

One must always keep in mind that swallowing difficulty associated with weight loss and decreased appetite is a sign of cancer. Cancer of the food pipe or esophageal cancer usually presents this way. The patients complain that they feel food stuck in throat. It worsens with time causing pain and weight loss gradually. Abnormal growth in any part of the respiratory tract or digestive tract may cause this symptom.

We request our readers to not get anxious when they have dysphagia. At the same time, please do get an expert opinion. Allay your fears and get a consult from us.

WHAT TO EXPECT IN AN ENT CLINIC?

When you present to an ENT specialist with these symptoms, firstly, he will find out the cause for your problem. The doctor will take a detailed history followed by an examination. He may use an endoscope to check the throat. He will do any of the following if there is a need-

1. X-Ray – the ENT may order X-Ray of neck or chest
2. Laryngoscopy – using a mirror or en endoscope. We use flexible and rigid endoscopes in our office. We let the patient decide which scope they want to be used.
3. Opinion from a Gastroenterologist – A gastroenterologist is specialist who deals with the food pipe and rest of the digestive system. An endoscopy may be necessary to check the food pipe.
4. X-Ray or Videofluroscopy after Barium Swallow – Barium produces a contrast in the film. It helps identify a lot of conditions.

HOME REMEDIES

There are a few things that you can do if you experience difficulty in swallowing. If you experience difficulty in swallowing, break the food into smaller pieces before swallowing. Chew more generously. You may take food in a semi-solid state to aid in swallowing. Next, you may take a few sips of water in the middle of a meal to prevent dryness. Some patients report the benefits of eating banana. The semi-solid consistency of banana helps clear any foreign object lodged in the pathway thereby making way for easy swallows. Do not eat a very cold meal. Avoid drinking very cold water and carbonated drinks. Quitting smoking will definitely help. Please drink in moderate amounts. Do not drink very late in the night.

TREATMENT

The ability to swallow properly ensures proper nutrition. We should not ignore problems of long term difficulty in swallowing. The treatment offered varies based on the diagnosis. We have a plethora of options for treatment of difficulty in swallowing. Based on what the cause is the treatment varies from simple to complex methods. In certain cases it may involve surgery as well.

In simple cases, we try diet modifications and swallowing exercises. We have experienced speech language pathologists in our team who will guide you. They will help those with neurological problems to practice maneuvers to strengthen the muscles of tongue and throat. We also have rehabilitative and compensatory methods for improving swallowing. Talk to our experts to find out which treatment option is the best for you.