Swallowing Issues – Dysphagia Causes and Treatment Options

Swallowing is an intricate process that we usually perform subconsciously. However, when there are disruptions in this complex mechanism, it can lead to dysphagia, which refers to difficulties in swallowing. Symptoms may include coughing, choking, and difficulty breathing.

While occasional swallowing problems may not cause significant complications, chronic dysphagia can indicate an underlying health condition or result in more severe issues. That’s why it is essential to seek expert diagnosis and treatment from a specialized ENT professional like Dr Stephen Kleid.

Dr Kleid, a renowned Ear, Nose, and Throat specialist in Australia, possesses extensive expertise in managing a wide range of ENT conditions, including swallowing problems. With his comprehensive knowledge and experience, he offers personalized diagnosis and treatment options tailored to your unique needs.

What Is Dysphagia?

Swallowing is a complex process involving three phases:

  • Oral Phase -This initial phase takes place in the mouth and is under conscious control. It involves chewing and forming food to be swallowed.
  • Pharyngeal Phase – The second phase is involuntary and relies on reflexes that propel the food down the throat and into the esophagus.
  • Esophageal Phase – The final phase involves coordinated contractions of the throat and esophagus, facilitating the movement of food from the throat to the stomach.

When there are difficulties or abnormalities in any of these phases, it is referred to as dysphagia. Dysphagia is characterized by the need for extra time and effort to move food or liquid from the mouth to the stomach. It can be accompanied by pain and, in severe cases, may make swallowing impossible.

Difficulty swallowing typically indicates an issue with the esophagus or throat. The esophagus is a muscular tube that transports food and liquid from the back of the mouth to the stomach, beginning where the throat ends.

Occasional dysphagia, (often experienced when eating too quickly or not chewing food adequately), is usually not a cause for concern. However, persistent or worsening swallowing difficulties may indicate an underlying medical condition that requires attention.

Recognizing the Symptoms of Dysphagia

Dysphagia, can manifest symptoms in various areas from the mouth to the esophagus. While dysphagia is generally not life-threatening, it is important to be aware of its signs and symptoms, which can range from mild to severe and may worsen over time.

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.

If you experience any of these symptoms persistently or if they worsen over time, it is important to consult with a healthcare professional for an evaluation and appropriate management of dysphagia. Early diagnosis and treatment can help improve swallowing function and overall quality of life.

What Are The Causes Of Dysphagia?

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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. The main causes of dysphagia are underlying health conditions that affect these muscles and nerves. 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 that can contribute to 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 tumour’s 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 esophagus
  • Myotonic dystrophy (DM), progressive muscle wasting and weakness which can involve your throat and esophagus
  • 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

Understanding the Types of Dysphagia

High or Oral Dysphagia

High dysphagia refers to swallowing difficulties that originate in the oral cavity or mouth. It primarily affects the first phase of swallowing when food or liquid is moved to the back of the mouth.

This type of dysphagia is often associated with neurological problems that weaken the nerves or muscles involved in swallowing. Conditions such as stroke or muscular dystrophy can lead to high dysphagia.

Pharyngeal Dysphagia

Pharyngeal dysphagia, also known as oropharyngeal dysphagia, affects the pharyngeal phase of swallowing. During this phase, food or liquid travels from the throat to the esophagus.

Pharyngeal dysphagia is typically associated with neurological problems that affect the nerves responsible for swallowing. Conditions like Parkinson’s disease and amyotrophic lateral sclerosis (ALS) can impact the function of the muscles in the throat and pharynx, leading to swallowing difficulties.

Low or Esophageal Dysphagia:

Esophageal dysphagia occurs during the esophageal phase of swallowing. Individuals with esophageal dysphagia experience a sensation of food or liquid getting stuck in the esophagus due to blockages or muscle irritation. This type of dysphagia often requires surgical intervention for treatment.

It is important to note that dysphagia is distinct from odynophagia and globus:

  • Odynophagia: Odynophagia refers to pain experienced while swallowing. It is different from dysphagia, which involves difficulty in swallowing. However, both odynophagia and dysphagia can occur simultaneously.
  • Globus: Globus is the sensation of something being stuck in the throat, often described as a lump or a tightness. While globus can sometimes be related to dysphagia and occur alongside it, it has a separate meaning and should not be confused with dysphagia or odynophagia.

What Are The Risk Factors Of Swallowing Problems?

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

Here are some risk factors associated with dysphagia:

  • Age
  • 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
  • Swallowing test
  • Videofluoroscopic assessment
  • Nasoendoscopy
  • Diagnostic Gastroscopy

Dysphagia – Contributing Factors

Various factors can contribute to dysphagia, and the appropriate treatment options depend on the specific cause. Some common causes of dysphagia include:

  • Esophageal Stricture
    • Narrowing of the esophagus due to inflammation, scar tissue, or tumors.
  • Gastroesophageal Reflux Disease (GERD)
    • Stomach acid flowing back into the esophagus, causing irritation and narrowing.
  • Achalasia
    • Dysfunction of the esophageal muscles, resulting in impaired relaxation and movement.
  • Neurological Conditions
    • Conditions like stroke, Parkinson’s disease, or multiple sclerosis that affect the nerves controlling swallowing.
  • Structural Abnormalities
    • Tumors, diverticula, or abnormal growths in the esophagus or throat.
  • Muscle Weakness
    • Weakening of the muscles involved in swallowing, often seen in conditions like muscular dystrophy or myasthenia gravis.

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.

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.

Treatment Options

Treatment options for dysphagia depend on the underlying cause and may include:

  • Dietary Modifications
    • Altering the texture or consistency of food and liquids to make swallowing easier.
    • Dr Kleid may advise you to take a special liquid diet that helps you avoid dehydration and maintain your weight.
  • Swallowing Therapy
    • Working with a speech-language pathologist to learn techniques and exercises that improve swallowing function.
  • Medications
    • Prescribing medications to manage underlying conditions, such as acid reflux or muscle relaxants to aid in swallowing.
  • Dilation
    • Stretching narrowed areas of the esophagus to improve the passage of food.
  • 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
      • Avoid caffeine
      • Avoid tobacco
      • Quit alcohol
      • Proper throat clearing
  • Surgery
    • In some cases, surgical intervention may be necessary to address structural abnormalities or remove blockages.
    • More information regarding surgery below in Treatment for severe cases of Dysphagia

If you are experiencing persistent swallowing difficulties, it is important to consult a healthcare professional for a comprehensive evaluation. They can determine the cause of your dysphagia and recommend an appropriate treatment plan to improve your swallowing function.

Treatment for severe Case of Dysphagia

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 esophageal stricture
  • Blocked throat
  • Bony outgrowths
  • Pharyngeal cancer
  • Vocal cord paralysis
  • Neurological disorders
  • Achalasia, (motility disorder of the esophagus)
  • Gastroesophageal reflux disease,( the acidic content of your stomach goes back to your throat)
  • Pharyngoesophageal diverticulum, (tightening of the upper esophageal 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
    • 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 come 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 esophageal 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.

Outcome

Swallowing problems 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 dependent 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.

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 and 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)
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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.

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The information presented in this article is provided solely for educational and informational purposes. It is not intended to substitute professional medical advice, diagnosis, or treatment. Always consult with your physician or qualified healthcare provider regarding any medical condition or concerns you may have. Do not disregard or delay seeking professional medical advice based on the information provided in this article. The author and publisher of this article do not warrant the accuracy, applicability, or completeness of the content, and any reliance on the information presented is at your own discretion and risk.