Swallowing Issues – Dysphagia Causes and Treatment Options

Swallowing is an unconscious process. It’s something we do every day without needing to think about it. But there are a lot of complicated processes behind it. Swallowing is a complex process involving several muscles and nerves, and most importantly, your brain.

When something disrupts this swallowing mechanism, it causes “dysphagia” or swallowing problems. It can present as coughing, choking, and/or difficulty breathing.

Occasional swallowing problems can be observed from time to time that typically don’t lead to severe complications. However, chronic dysphagia can reveal an underlying health condition or result in severe complications.

Leading Australian Ear, Nose, and Throat (ENT) specialist, Dr Stephen Kleid, offers expert diagnosis and treatment for various ENT conditions, including but not limited to swallowing problems. Dr Kleid and his experienced surgical and non-surgical treatment for dysphagia, and aftercare are customized for both you and your needs.

What Is Dysphagia?

Swallowing occurs in three phases:

  • The first phase of swallowing occurs in the mouth and is, in fact, the only one you can control.
  • The second is involuntary and involves reflexes which move food down your throat.
  • And, the third and final phase entails coordinated throat and oesophagus contractions that move the food from your throat to your stomach.

Dysphagia is the medical term used to describe swallowing problems or difficulty swallowing. It’s when you need extra time and effort to move liquid or food from your mouth to your stomach. Pain may accompany your dysphagia, and in some cases, swallowing may even be impossible.

Difficulty swallowing usually indicates a problem with either your oesophagus or throat. The oesophagus is a muscular tube that moves both food and liquid from the back of your mouth down to your stomach. It begins where your throat ends.

You’ve probably experienced occasional dysphagia when you eat too fast or don’t chew your food correctly. Most cases of occasional swallowing difficulty are not a cause for concern. However, if it persists, it could be a sign of an underlying medical condition.

Many factors can cause dysphagia, and the treatment options depend on the specific cause of your dysphagia.

What Are The Types Of Dysphagia?

High Or Oral Dysphagia

This is a swallowing problem that originates in either your oral cavity or mouth. It affects the first or oral phase of swallowing when you move the food to the back of your mouth.

Neurological problems that weaken your nerves or muscles, like either a stroke or muscular dystrophy (weakness), typically cause high dysphagia.

Pharyngeal Dysphagia

It’s also known as oropharyngeal dysphagia. Pharyngeal dysphagia affects the pharyngeal phase of swallowing when food or liquid travels from the throat to the oesophagus. It’s associated with neurological problems that affect the nerve responsible for swallowing, such as Parkinson’s disease and amyotrophic lateral sclerosis (ALS). Both of these affect the function of the muscles in your throat and pharynx.

Low Or Esophageal Dysphagia

Oesophagal dysphagia affects the oesophagal phase of swallowing. Food or liquid feels stuck in the oesophagus because of a blockage or irritation of your muscles. Oesophagal dysphagia almost always requires surgery to treat.

To clear up a common misconception, dysphagia is not the same as odynophagia and globus.

Dysphagia is a difficulty with swallowing, whereas, odynophagia is pain with swallowing. However, the two can occur at the same time.

Globus, on the other hand, is the feeling of something stuck in your throat. Although they can be related and occur together, these three terms have separate meanings and shouldn’t be confused.

Why Choose Dr Kleid for Ear, Nose and Throat Surgery?

Dr Stephen Kleid
Ear Nose and Throat Surgeon (Otolaryngologist)

Masada Medical Centre
26 Balaclava Road,
East St Kilda, Victoria

Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in St Kilda.

Dr Kleid’s Procedures

What Are The Symptoms Of Dysphagia?

Dysphagia stems from problems in your oral cavity to your oesophagus. So, you can experience symptoms in your mouth, throat, and even your chest.

Typically, it isn’t a life-threatening condition, but its signs and symptoms can range from mild to severe and can even worsen with time.

The symptoms of dysphagia may include:

  • Drooling
  • Hoarseness
  • Regurgitation, bringing food back up
  • Choking while eating
  • Unexplained weight loss
  • Difficulty controlling food in the mouth
  • Recurring heartburn
  • Recurring pneumonia
  • Not able to control saliva in the mouth
  • Problem with starting the swallowing process
  • Gagging or coughing while swallowing
  • Acid from the stomach backing up into the throat
  • Feeling as if food is stuck in the chest, throat, behind the sternum, or breastbone

When To See A Doctor About Difficulty Swallowing?

If you regularly have swallowing problems, then it’s time to seek medical advice and care. More importantly, if your dysphagia is accompanied by either vomiting, regurgitation, or weight loss, contact a medical professional immediately.

Always seek emergency help when you have sudden muscle paralysis or an obstruction in your throat that disrupts breathing.

What Are The Causes Of Dysphagia?

Dysphagia occurs when there is an issue with any part of your swallowing process. Swallowing is a complex process involving both the muscles and nerves from your mouth to your stomach. An underlying health condition that affects these muscles and nerves mainly causes dysphagia.

We can divide the causes of swallowing problems into the following categories:

Congenital And Developmental Conditions

Congenital conditions are conditions you were born with. Developmental conditions are those that affect the way you develop. Conditions like these affect the developing body system, including the organs and tissues involved in swallowing.

Common congenital and developmental conditions causing dysphagia include:

  • Learning disabilities
  • Cerebral Palsy
  • Either Cleft lip or palates
  • Tongue-tie
  • Down’s syndrome

These conditions often present as pediatric dysphagia, (swallowing problems) in children.

Neurological Conditions

Your nerves, spinal cord, and brain form your nervous system. Injury or damage to either the brain or spinal cord can cause neurological disorders that affect the nerves and muscles controlling swallowing. These neurological conditions may include:

  • Stroke
  • Brain tumour
  • Parkinson’s disease
  • Multiple scleromata
  • Dementia
  • Motor neuron diseases
  • Myasthenia gravis, weakening of skeletal muscles
  • Duchenne muscular dystrophy, progressive muscle degeneration and weakness

Obstruction

Any obstruction in your throat can lead to difficulty swallowing. Conditions that result in tumours or scars in the mouth and throat can either narrow or block your throat. When this happens, it disrupts the swallowing process.

Causes of obstruction in dysphagia may include:

  • Gastroesophageal reflux disease, the acidic content of your stomach goes back to your throat causing scarring and narrowing
  • Mouth cancer
  • Esophageal cancer
  • Laryngeal cancer
  • Throat cancer
  • Respiratory cancer
  • Radiation therapy treatments
  • Tuberculosis

Muscular Conditions

To achieve swallowing, your mouth and throat muscles need to work together to push the food down to your stomach. Although these are rare, some disorders can affect these muscles that aid swallowing. But these muscular conditions affect those muscles by making them too weak or too tight. They are:

  • Achalasia, is a neuromuscular disorder that affects the motility of the oesophagus
  • Myotonic dystrophy (DM), progressive muscle wasting and weakness which can involve your throat and oesophagus
  • Oculopharyngeal muscular dystrophy (OPMD), is a disorder that causes weakness in the muscles of the pharynx and eyes.

Other causes of dysphagia may include:

  • Muscles getting weak due to ageing
  • Chronic obstructive pulmonary diseases (COPD), a group of lung diseases that makes breathing and swallowing difficult
  • Complications from head or neck surgery

What Are The Risk Factors Of Swallowing Problems?

Although swallowing problems can affect everyone, certain factors can weaken or tighten the oesophagus muscles. They can also cause narrowing and blockage of the throat.

Here are some risk factors associated with dysphagia:

  • Age, children and elderly
  • Alcohol consumption
  • Dementia
  • Obesity
  • Smoking
  • Stroke
  • Hiatal hernia
  • Caffeine consumption
  • Scleroderma

Some medications can put you at risk of developing dysphagia. They can either make initiating the swallowing process difficult or cause aspiration. Some medicines may also elicit a choking and coughing sensation.

  • Anticholinergics, used for treating seasickness
  • Dopamine, used for treating Parkinson’s disease
  • Beta-blockers, used for treating both high blood pressure and heart diseases
  • Calcium channel blockers, used for treating high blood pressures
  • Bronchodilators for asthma
  • Drugs for anxiety and insomnia
  • Any tricyclic antidepressants

How To Diagnose Dysphagia?

The majority of the time, swallowing problems can either be undiagnosed or untreated. This increases your risk of developing dehydration, or worse, silent aspiration. Silent aspiration is a lung condition caused by inhaling either saliva or food particles by accident. This is especially dangerous in the elderly population and can lead to adverse effects.

Before Dr Kleid diagnoses dysphagia and swallowing assessments. He takes into account your weight, medical history and symptoms, as well as, their duration. He also notes if liquid or solid food swallowing was affected.

Dr Kleid may refer you to a neurologist, gastroenterologist, or speech-language therapist for further investigation into the cause of your dysphagia. Diagnostic tests for dysphagia include:

Impedance and pH test

For detecting acid reflux diseases. It tests the acidity in your oesophagus.

Swallowing test

A swallowing test assesses your swallowing abilities. A speech therapist will evaluate your lips, tongues, and throat muscles. They may also observe the time it takes you to swallow and the number of tries you need.

Videofluoroscopic assessment

This is an imaging test that shows your swallowing in real time. Barium, a non-toxic liquid, makes it possible for your swallowing to be visible on X-rays. The side effects include constipation due to the barium.

Nasoendoscopy

This is an endoscopic visual exam Dr Kleid uses to examine your nose and upper airway to search for and identify problems like blockage. It is also known as Fiberoptic Endoscopic Evaluation Of Swallowing (FEES). In this exam, Dr Kleid inserts a fine scope through your nose and advances it downward to visually inspect your pharynx.

Diagnostic Gastroscopy

This is a particular test for oesophagal dysphagia. It is also known as an esophagogastroduodenoscopy (EGD). It makes use of an endoscope, a flexible tube with a light and a camera, to inspect your throat, oesophagus, and stomach.

What Are The Treatment Options For Dysphagia?

The treatment options for swallowing disorders we recommend will depend on the type of dysphagia you have and what’s causing it.

Dr Kleid treats dysphagia along with an entire multidisciplinary team that may comprise of a speech-language pathologist, swallowing therapist, occupational therapist, speech pathologist, respiratory therapist, and gastroenterologist, to name a few.

Swallowing Therapy

Speech-language pathologists or swallowing therapists may help you carry out specific exercises, which aim to help you coordinate your muscles for swallowing.

These exercises also help restore the nerves responsible for triggering the swallowing reflex.

If your dysphagia is caused by Alzheimer’s disease or Parkinson’s disease, you will require new exercises and swallowing techniques. You may learn ways to place and position your head and body for swallowing to compensate for your dysphagia.

Medications

In many cases of dysphagia, you can use oral prescriptions for treatment. In gastroesophageal reflux diseases, antacids are commonly prescribed. Corticosteroids are also recommended in cases of eosinophilic esophagitis, an inflammatory disorder of the oesophagus. Muscle relaxants are used for severe muscle spasms, such as achalasia.

Dietary Changes

Sometimes you may develop severe dysphagia, which prevents you from drinking and eating. In those cases, Dr Kleid will advise you to take a special liquid diet that helps you avoid dehydration and maintain your weight.

Feeding Tubes or Nasogastric Tubes

In severe cases of dysphagia, a feeding tube can be used to bypass your disrupted swallowing process to provide you with the necessary nutrition. A nasogastric tube passes through your nose down to your stomach. These tubes are meant to be replaced every month and switched to the opposite nostril. They are the last resort, usually used in incapacitated patients that fail traditional therapy.

Dysphagia Surgery

Dr Kleid only recommends surgery to treat dysphagia when your swallowing problem is caused by:

  • Narrow throat or oesophagal stricture
  • Blocked throat
  • Bony outgrowths
  • Pharyngeal cancer
  • Vocal cord paralysis
  • Neurological disorders
  • Achalasia, motility disorder of the oesophagus
  • Gastroesophageal reflux disease, the acidic content of your stomach goes back to your throat
  • Pharyngoesophageal diverticulum, tightening of the upper oesophagal sphincter.

The type of dysphagia surgical procedure that Dr Kleid will perform depends on the cause and type of your condition. Surgery for swallowing disorders may include:

Cricopharyngeal Myotomy

In this procedure, Dr Kleid cuts the cricopharyngeal muscle to allow swallowing. The muscle is located at your lower neck. This procedure is used to treat achalasia, where the muscle contractions narrow the oesophagus and cause swallowing problems.

Vocal Fold Injection

In this procedure, Dr Kleid injects permanent or temporary bulking materials into your vocal folds. They help move paralysed vocal cords to the middle and closer to each other. This prevents any food from ending up in the windpipe and redirects it to the oesophagus.

Laryngeal Framework Surgery

This procedure is also used by Dr Kleid to move the vocal cords closer to the middle. It requires an external cut in your voice box and an implant that adds bulk to the cords.

Laryngotracheal Separation

If you have recurrent aspirations that lead to repeated pneumonia, Dr Kleid can completely detach your gullet from your airways.

This is the last resort to use if your dysphagia is in the context of:

  • A stroke
  • Amyotrophic lateral sclerosis
  • Parkinson’s disease
  • Multiple sclerosis

Palatoplexy

If you suffer from soft palate paralysis, the food can regurge back into your nose. Dr Kleid uses palatoplexy or palatoplasty to repair your soft palate by stitching part of it permanently to the back of your throat.

Zenker’s Diverticulum Surgery

When your upper oesophagal sphincter fails to relax to allow swallowing, it causes oesophagal outpouching. This outpouching is known as Zenker’s diverticulum.

When food collects in this pouch, it could cause aspiration, choking, or regurgitation. Dr Kleid uses either cricopharyngeal myotomy or an endoscopy surgery to resolve it. An endoscopic surgery separates the outpouching from your gullet.

Lifestyle Changes

For milder cases of swallowing problems, sometimes all you need are lifestyle changes. These are either planned and managed by your speech therapist, speech pathologist, or physical therapist.

You don’t require drastic lifestyle changes to treat dysphagia. Some applicable changes to follow include:

  • Change your eating habits if you have to
  • Avoid caffeine
  • Avoid tobacco
  • Quit alcohol
  • Proper throat clearing

What Are The Complications Of Dysphagia?

Untreated swallowing issues can evolve into more significant problems. One common problem is choking or coughing when food goes down the passage, such as your airways.

When this happens, serious chest infections like aspiration pneumonia may develop. This unfolds when you accidentally inhale water or food particles. Silent aspiration requires urgent medical treatment.

We urge you to seek medical assistance when you notice the following signs:

  • Coughing while eating or drinking
  • Difficulty breathing
  • Wet gurgle sound while eating or drinking

Another complication associated with untreated dysphagia is dehydration and malnourishment. This may result from your fear of eating and swallowing because of the pain associated with swallowing.

If you’re taking care of an elderly family member, you should keep these complications in mind. They are a common cause of morbidity among dependent individuals.

Several treatment options mentioned above can remedy and prevent this.

Outcome

Swallowing problems can affect the quality of your life. It can prevent you from enjoying your meals and attending social occasions. In the very young and very old, it can lead to more serious complications like lung infection and choking.

So it’s best to maintain a healthy lifestyle and seek consultation to avoid the possibility or the recurrence of dysphagia. If you or your dependant start developing suspicious signs of a swallowing issue, seek medical help as soon as possible. Complications of untreated dysphagia are severe and may become life-threatening.

Don’t hesitate to contact Dr Stephen Kleid. As a skilled ENT surgeon, Dr Kleid is the choice practitioner for expert care in Melbourne, Australia.

FAQs

What could cause swallowing problems?

The most common cause of dysphagia is an obstruction in your throat. But congenital, neurological, and muscular conditions affect the muscles and nerves involved in the swallowing process. Thus, they are also causes of dysphagia.

What are the symptoms of swallowing problems?

Signs of swallowing problems can range from mild to severe. You may experience drooling, regurgitation, coughing, unexplained weight loss, and difficulty starting the swallowing process.

When should I be worried about my swallowing problems?

You should be concerned about dysphagia if you have difficulty breathing or a feeling of something stuck in your throat. If you are taking care of a child or an elderly person, dysphagia should immediately be addressed to avoid dangerous complications.

When should I go to the ER for difficulty swallowing?

Your swallowing problem becomes an emergency when you choke on food and can’t breathe. The feeling that something is stuck in your throat or chest also warrants emergency help.

Can difficulty swallowing go away?

Many cases of dysphagia are temporary and can go away on their own without any medical intervention. Nevertheless, persistent swallowing problems need to be addressed to avoid complications.

Can dysphagia be cured?

In most cases, you can manage dysphagia with the available treatments and swallowing surgery. For more severe cases, dysphagia may not be totally cured. Seek advice from an ENT specialist such as Dr Stephen Kleid for your best treatment options.

How long can a swallowing problem last?

It has been medically and scientifically proven that most people who suffer from dysphagia recover within two weeks. In many cases, however, dysphagia can be permanent if not surgically treated.

What is a swallowing test?

A swallowing test or study is a test that shows the actions of your throat while you swallow. Surgeons frequently order this test to evaluate and diagnose swallowing disorders.

What foods should be avoided with dysphagia?

You should avoid whole fruit, lumpy cereals, pastries, chewy candies, nuts, and seeds to prevent pain and worsening of your dysphagia.

What medication causes swallowing problems?

Some medicines can put you at risk of developing dysphagia, such as anticholinergics, dopamine, beta-blockers, bronchodilators, and calcium channel blockers, to name a few.

Sources


Why Choose Dr Kleid for Ear, Nose and Throat Surgery?

Dr Stephen Kleid
Ear Nose and Throat Surgeon (Otolaryngologist)

Masada Medical Centre
26 Balaclava Road,
East St Kilda, Victoria

Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in St Kilda.

Dr Kleid’s Procedures

How can we help?

Dr Kleid’s Team takes pleasure in assisting you with any questions when considering ENT surgery. Please call the Masada in Melbourne between 9 am – 5 pm on Weekdays.

Phone Masada Hospital 03 9038 1630 or Email Dr Kleid