Difficulty Swallowing

There are twelve possible conditions that can make swallowing difficult. When a person finds it difficult to swallow, it could be due to several reasons. It can be considered an inductive medical condition, but the causes behind it need to be determined. It can be a temporary state and may return to normal after some time passes.

Trouble swallowing may be due to an obstruction in the throat, such as trapped food or a swollen throat. It could be a symptom of a medical condition that causes the esophagus to become inflamed. Under normal circumstances, a swollen tongue or irritation in the oral cavity can also cause swallowing difficulties.

Other conditions that cause difficulty swallowing include:

• Dry throat, or the state of xerostomia
• Severe stroke
• Dementia
• Head or neck cancer
• Serious degenerative diseases like Parkinson’s and multiple sclerosis
• Allergic reaction
• Swollen tonsils
• Gastroesophageal reflux disease (GERD) 

As per the study by the National Institute on Deafness and Other Communication Disorders, there are about fifty pairs of muscles and nerves that are normally used to help a person swallow. Problems with any one of these muscles or nerves can lead to trouble swallowing.

Types of Dysphagia

Generally, the process of swallowing occurs in four stages:

1. Oral preparatory
2. Oral
3. Pharyngeal
4. Esophageal

Difficulty swallowing can be broken down into two categories, namely, oropharyngeal, which combines the first three stages, and esophageal.

Oropharyngeal Dysphagia

Oropharyngeal dysphagia is a condition mainly caused by throat disorders. If the muscle or nerves in the throat become swollen or damaged, it can lead to problems swallowing, as well as choking and gagging while trying to eat or swallow.

Oropharyngeal dysphagia is caused by various conditions, such as:

• Multiple sclerosis
• Parkinson’s disease
• Nerve damage from surgery or radiation therapy
• Post-polio syndrome

According to medical reports, oropharyngeal dysphagia may also be caused by esophageal cancer or head or neck cancer. It can seriously affect the upper portion of the throat as well as the pharynx, or the pharyngeal pouches, which are used to hold food.

There are several reason behind the throat disorder, including:

• Spasms or tightness in the lower esophagus
• Throat constriction due to narrowing of the esophagus
• Food particles unable to be passed into the throat
• Scar tissue in the esophagus due to chronic inflammation or post-radiation treatment

Other symptoms that make swallowing difficult are:

• Excessive drooling
• Hoarse voice
• Food becoming stuck in the throat
• Feeling of spewing
• Sudden weight loss
• Heartburn
• Cough or choking while swallowing
• Pain while swallowing
• Difficulty chewing solid foods
• Loss of appetite

Children may also experience difficulty swallowing due to:

• Inability to eat certain foods
• Food or liquid leaking from the mouth
• Regurgitation during meals
• Trouble breathing while eating
• Weight loss

There are specialized tests that can help find the exact cause of the codntion. These include:

• Barium X-ray: A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you swallow liquid or a pill containing a dye that shows up on an abdominal X-ray. The doctor looks at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This helps identify any weaknesses or abnormalities.
• Videofluoroscopy: A videofluorscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called a fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of one’s swallow. During the examination, you swallow a variety of consistencies ranging from purees to solids, and thin and thickened liquids. This helps the doctor detect the ingestion of food and liquid into the trachea. This information can be used to diagnose muscle weakness and dysfunction.
• Endoscopy: An endoscopy may be used to check all areas of the esophagus. During this examination, the doctor inserts a very thin, flexible tube with a camera attachment into the esophagus. This allows the doctor to see the esophagus in detail.
• Manometry: A manometry is another invasive test that can be used to check the inside of the throat. More specifically, this test checks the pressure of the muscles in the throat when you swallow. The doctor inserts a tube into the esophagus to measure the pressure on the muscles when they contract.

Swallowing difficulties cannot be prevented, and it is necessary to have dysphagia treated as soon as possible. Taking the advice of a speech-language pathologist is always useful and helps a person perform the swallowing evaluation, which is part of the diagnosis for dysphagia. If the evaluation is completed successfully, then, according to the recommendations of the speech pathologist, you may have to change your diet.

Diet Modification 

Oropharyngeal swallowing exercises and compensatory swallowing strategies help strengthen the throat muscles.

Postural modifications are necessary and become part of exercises while eating. However, if swallowing problems persist, they can result in malnutrition and dehydration, especially in very young and older adults. Recurrent respiratory infections and aspiration pneumonia are also likely. All of these complications are serious and life-threatening and must be treated immediately. If your swallowing problem is caused by a tightened esophagus, a procedure called an esophageal dilation may be used to expand it. During this procedure, a small balloon is placed into the esophagus to widen it. The balloon is then removed.

If there are any abnormal growths in the esophagus, surgery may be necessary to remove them. Surgery may also be used to remove scar tissue.