Swallowing Disorders


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Related to Swallowing Disorders: dysphagia, Swallowing difficulties

Swallowing Disorders

 

Definition

Swallowing disorders include a number of diseases and conditions that cause difficulty in passing food or liquid from the mouth to the stomach.

Description

Although normally swallowing is automatic, it is a complex process involving several phases and 29 muscles. Saliva helps soften food as it is chewed. The tongue helps move food to the back of the mouth, triggering a swallowing reflex that passes food through the pharynx. The epiglottis helps keep food from mistakenly going down the windpipe and into the esophagus, the canal that carries food to the stomach. Swallowing disorders can occur at any phase in the swallowing process. The medical term for difficult swallowing is dysphagia.
Each year, about 10 million people in the United States require medical evaluation for swallowing problems. Some experts say that about 10% of Americans develop symptoms of swallowing disorders in adulthood. Elderly people are the most likely to have problems with swallowing.

Causes and symptoms

Swallowing disorders often result from other conditions and diseases. For example, Parkinson's disease, cerebral palsy, stroke, head injury, and other central nervous system conditions can damage the muscles and nerves involved in swallowing. Some people are born with abnormalities in the swallowing structures, such as infants with cleft palate.
Some cancers can lead to swallowing disorders. Esophageal cancer can cause narrowing and eventual blockage of the esophagus. Surgery and radiation therapy for head and neck cancer can restrict or weaken tongue motion, paralyze vocal cords, or cause muscle damage that affects swallowing. An inflamed esophagus, often resulting from gastroesophageal reflux disease (GERD), can cause painful or difficult swallowing. Infections of the esophagus also can inflame it and cause it to narrow. Swallowing difficulty may result from aging, though researchers are not certain why.
The most common symptoms people report are choking and the feeling that food feels stuck in the throat. Other symptoms include needing to swallow many times to clear food from the mouth and throat, a gurgly, wet sound to the voice after swallowing, having to clear the throat after eating, coughing, pain while swallowing, bringing food back up (regurgitation), food or acid backing up into the throat, unexpected weight loss, and not being able to swallow at all. Children also may gag during meals and may have excessive drooling or leaking of food or liquid from their mouths during meals. They may have difficulty breathing when eating or drinking, spit up frequently and lag behind in weight gain. They also may have recurring pneumonia or respiratory infections.

Diagnosis

A physician should perform a full head and neck examination based on the patient's symptoms. Speech-language pathologists may aid in the diagnosis. Physicians also might order a swallowing test to study how the patient swallows. The patient will be asked to drink a liquid with a contrast agent called barium that will show up on x rays of the throat and upper chest. The exam might be imaged with a technique called video fluoroscopy, which will take motion camera images in addition to still images. For this exam, the patient may be asked to swallow liquid, paste, and solids. A speech pathologist may work with the radiologist to perform this exam.
If the physician thinks the problem originates in the lower esophagus or has concerns about an abnormality in the esophagus, an endoscopy may be ordered. This test involves passing a thin, flexible instrument called an endoscope down the throat. The lighted endoscope helps the physician view the esophagus. Other tests may be used, including ultrasound.

Treatment

Treatment will depend on the cause of the swallowing problem. Special exercises may help strengthen the muscles used for chewing and swallowing. Problems originating in the mouth may be treated with artificial saliva, improved hydration or better dental care. Esophageal problems will be treated depending on the cause. Patients with GERD will receive medications and instructions on how to better manage the disease. Esophageal cancer is a life-threatening disease that will involve coordinating care with an oncologist. Many patients will receive help with their disorders from speech pathologists. Special liquid diets may be ordered for patients who continue to have trouble chewing or swallowing. In severe cases, the patient may need a feeding tube that bypasses the part of the swallowing system that does not work.

Alternative treatment

Some herbs that may help improve swallowing include oil of peppermint and licorice. Valerian may be used as a tea. Homeopathic physicians may suggest some remedies aimed at improving bloating, indigestion, or cough. Alternative care should be sought from licensed practitioners and coordinated with physician care.

Key terms

Cleft palate — An opening or hole in the roof of the mouth that occurs at birth when the roof fails to fully develop in the infant.
Epiglottis — A thin layer of cartilage behind the tongue that helps block food from entering the windpipe.
Pharynx — The muscular cavity that leads from the mouth and nasal passages to the larynx and esophagus.

Prognosis

In many cases, these disorders can be corrected. If not treated, swallowing disorders can lead to serious complications, including dehydration and malnutrition. There also is a risk of food entering the airway (aspiration) as a person attempts to swallow, which can lead to aspiration pneumonia as the food particles enter the lungs.

Prevention

Many causes of swallowing disorders cannot be prevented. Slowly and fully chewing food helps. People with GERD should manage it to lower the risk of developing swallowing difficulties.

Resources

Periodicals

"Disorders of Swallowing." Harvard Men's Health Watch (Sept. 2003).
"The Evaluation and Management of Swallowing Disorders in the Elderly." Geriatric Times (Nov. 1, 2003): 17.

Organizations

American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. 703-836-4444. http://www.entnet.org.
American Speech-Language Association (ASHA). 10801 Rockville Pike, Rockville, MD 20852. 800-638-8255. http://www.asha.org.
National Institute of Dental and Craniofacial Research (NIDCR). 45 Center Dr., Rm 4AS19 MSC 6400, Bethesda, MD 20892-6400. 301-496-4261. http://www.nidr.nih.gov.

Other

Dysphagia. Web page. National Institute on Deafness and Other Communication Disorders, 2005. http://www.nidcd.nih.gov/health/voice/dysph.asp.
NINDS Swallowing Disorders Information Page. Web page. National Institute of Neurological Disorders and Stroke, 2005. http://www.ninds.nih.gov/disorders/swallowing_disorders/swallowing_disorders.htm.

swallowing

the taking in of a substance through the mouth and pharynx and into the esophagus. It is a combination of a voluntary act and a series of reflex actions. Once begun, the process operates automatically. Called also deglutition.

swallowing disorders
difficulty in swallowing may be caused by foreign body obstruction, by inflammation of the lining or by a defect in nervous control. The nerves involved are the sensory and motor branches of the trigeminal nerve, the hypoglossal, the facial and the glossopharyngeal nerves. Called also dysphagia.
swallowing reflex
begins as soon as the bolus of ingesta approaches the entry to the pharynx. In a series of reflex actions: breathing is halted, the soft palate elevates and closes the entrance to the nasal cavities, the tongue is clamped into the fauces, closing the exit from the pharynx back into the mouth, the epiglottis closes off the larynx, the pharynx contracts and forces the bolus into the esophagus, peristalsis-like movements in the esophagus carry the food to the cardia which relaxes and the food is propelled into the stomach. Called also palatal reflex.
repeated swallowing
a sign of partial esophageal obstruction.

Patient discussion about Swallowing Disorders

Q. mouth ulcer and difficulty to swallow, below right side of inner tongue guggle salt water and vinigar dose'nt help

A. how big is it? mouth ulcers has a reason why they happen. sometimes a broken tooth, biting a sharp metal, a prosthetic that doesn't sit well..that sort of things. but sometimes it is caused by other stuff. any way, oral hygiene may relieve some of the symptoms. Topical (rubbed on) antihistamines, antacids, corticosteroids, or other soothing preparations may be recommended for applying on top of the ulcer. Avoid hot or spicy foods.

More discussions about Swallowing Disorders
References in periodicals archive ?
Clinically, the majority of patients with rapidly growing mycobacterial infections associated with swallowing disorders or lipoid pneumonia present with fever and pulmonary infiltrates.
Siobhan McKeon, MS, CCC-SLP, is Assistant Director of the Department of Speech-Language and Swallowing Disorders, at Jewish Home Lifecare, New York.
More information about clinical indictors, neuroanatomical locations, and behavioral features will lead to earlier detection of swallowing disorders.
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Forty to 50 percent of residents have swallowing disorders, and may require two or three minutes to move food to the back of their mouths.
Swallowing disorders: Aspiration of injurious material from the mouth, such as saliva contaminated by infected teeth, is more likely if the child has a swallowing disorder.
For example, numerous disciplines participate in the teaching of the DECOD courses at the University of Washington: physical therapists from the Department of Rehabilitation Medicine demonstrate wheelchair transfer techniques, vocational counselors discuss psychosoical issues of disability, physiatrists lecture on various disabling conditions, nutritionists present concerns in nutrition, and speech pathologists provide dental professionals with basic information on speech and swallowing disorders.
Developed to illustrate the value of speech-language pathology services provided to people with swallowing disorders, cognitive and memory impairments, and communication disorders, NOMS is a data collection system, recognized by the Centers for Medicare and Medicaid Services (CMS).
Most of the 2008 second edition remains current, but enough had changed in a few crucial areas of swallowing disorders that a new edition was undertaken.
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In the coming years, a concerted research effort is needed to examine issues such as the validity, sensitivity and specificity of our diagnostic procedures and the efficacy of the treatment approaches and preventive measures we use to assist those with communication and swallowing disorders.