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