Dysphagia/Difficulty Swallowing

What is Dysphagia?

Dysphagia is a term that describes difficulty swallowing both solid and liquid foods. The condition results from various medical conditions that cause weakness and structural problems in the coordination of the mouth and throat muscles that direct food and/or liquids to travel down the trachea (“windpipe”) instead of the esophagus (“food pipe”). When food enters the windpipe instead of the food pipe, it can lead to a potentially dangerous condition called aspiration, which may lead to pneumonia if not treated.

What are the Symptoms?

Dysphagia may seem to be more severe at some times than others, or the condition may progress over time.

Some symptoms include:

• Difficulty getting food or liquids to go down the food pipe on the first attempt
• Coughing/choking during or after meals
• Unintentional weight loss
• Throat clearing
• Wet gurgling voice after eating
• Fever
• Chills
• Changes in breathing
• Food or liquids traveling back up through your throat or nose after you swallow
• Feeling of food or liquids being “stuck” in your throat or chest
• Pain while swallowing
• Feeling of heartburn
• Dehydration
• Excessive secretions
• Leakage of food or saliva from mouth or tracheostomy

When Should I See a Specialist?

Dysphagia specialists include otolaryngologists and speech language pathologists.

• If a person has problems breathing because something is stuck in their throat, call 911 immediately.  
• If you have had difficulty swallowing and are experiencing any of the symptoms listed for more than one week, you should see a medical specialist for evaluation of the swallowing difficulty.

What Causes Dysphagia?

Dysphagia may be caused by a number of conditions. It typically occurs in older adults but may also occur in children. Sometimes the muscles and nerves that move food through your mouth, throat, and esophagus are not working as they should.

Common causes include:

• Trauma to the head, neck, or spine
• Brain Injury
• Stroke
• Radiation treatments for cancers
• Diseases which affect muscle function such as Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS)
• Childhood syndromes such as Down’s syndrome and cerebral palsy
• Certain immune system disorders such as Sjogren’s syndrome, rheumatoid arthritis
• Spasms in the esophagus
• Narrowing of the esophagus
• Blockage of the esophagus
• Reflux (GERD or LPR) which may cause ulcers in the esophagus
• Diverticula, which are small pockets in the esophageal wall
• Tumors or masses on, or near the esophagus

How is Dysphagia Evaluated?

Dysphagia is evaluated by a multidisciplinary team that involves an otolaryngologist, speech pathologist, nutritionist, radiologist, gastroenterologist, and primary care physician with specialization in swallowing disorders.

First, a member of the dysphagia team will ask questions about your medical history and current swallowing problems. Next, imaging tests of the head and neck will be taken to help find the cause of the problem. These tests may include:

• A modified barium swallow study (MBS): This study is conducted by a speech pathologist and a radiologist to determine the nature of the swallowing difficulty. During MBS, barium representing different food consistencies is presented and motion imaging is recorded as these different consistencies are swallowed. The barium allows the person conducting the study to determine the nature of the swallowing difficulty and potential causes of aspiration.
• Flexible endoscopic evaluation of swallowing (FEES): In this procedure a small endoscope attached to a digital camera is placed through one nostril to visualize the throat as food and liquids are presented so that the doctors may assess where the swallowing difficulties are occurring. This study is conducted by a speech pathologist and an otolaryngologist.

After the above tests are completed, the speech pathologist will review the exam findings and determine the safest consistencies that an individual can eat. The speech pathologists will also discuss any compensatory maneuvers that can facilitate safe swallowing and assist with exercises that can facilitate safe swallowing.

Other tests that an individual may undergo if indicated are:

• Transnasal esophagoscopy (TNE): During this test, an endoscope is placed from the nose into the esophagus to determine any structural problems with the esophagus. This study is typically conducted by an otolaryngologist or gastroenterologist.
• Manometry: During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow. This test is performed by a gastroenterologist
• pH monitoring: This test helps determine how often acid from the stomach gets into the esophagus and how long it stays there.

What is the Treatment for Dysphagia?

Treatment varies depending on the exact cause of your dyspahgia.

Some treatments include:

• Exercises for swallowing muscles. This will help strengthen and balance the muscles needed for swallowing
• Use of compensatory strategies like tucking chin down or turning head to one side for swallowing
• Changing the foods you eat. Certain foods and liquids make swallowing easier
• Dilatation of the esophagus
• Botox injection to the esophagus to relax this muscle if it is tight and is blocking the food from entering into the esophagus
• Surgery if indicated
• Reflux medication if indicated