Swallowing Disorders

Swallowing

There are numerous types of swallowing disorders, causing a variety of symptoms. The following discomforts when swallowing could be indicative of a swallowing disorder and can be diagnosed & treated by one of our Westside Head & Neck Physicians:

Food sticking in the throat
Heartburn
Choking on food
Inability to swallow liquids
Pain when swallowing
Persistent cough or sore throat
Hoarseness or a gurgly voice during or after eating
A”lump in the throat” sensation
Wheezing without a history of asthma or lung problems

The 4 Stages of Swallowing:

Swallowing takes place in four stages. Different problems can occur at each stage to disrupt the normal swallowing process.

Stage I:

Biting and chewing food takes place in the mouth. At this stage, lack of strength, control or feeling in the mouth — which may be due to stroke or muscle or nerve disease — may cause food or liquid to fall directly into the throat and cause choking.

Stage II:

The tongue pushes the food to the back of the mouth where a structure folds over the top of the windpipe to keep food out. At the back of the mouth, the presence of food triggers muscle contractions. At this stage, the muscle at the back of the mouth that opens to allow food into the esophagus may malfunction and cause aspiration (food passing into the windpipe), which results in choking.

Stage III:

Muscle contractions push food down the esophagus. At this stage, lack of or inadequate muscle contractions may cause food to stick in the chest.

Stage IV:

Food moves through the esophagus, and the lower esophageal sphincter muscle opens to let food pass into the stomach. At this stage, weakening of this sphincter muscle at the stomach opening may allow acidic stomach secretions to come back up into the esophagus from the stomach, a condition called reflux.

Swallowing Problems Causes & Treatments

Swallowing problems may be temporary, or they may be an indication of a serious medical problem. There are many causes, including nerve and muscle problems, head and neck injuries and cancer. Or they may occur because of a stroke. Certain medications can also contribute to the disorder.

Diagnosis

Our physicians, who work closely with many of the top gastroenterologists (a physician who specializes in treating problems of the digestive system) in Los Angeles, can determine the location and the extent of the problem based on symptoms, a physical examination, diagnostic tests, and x-rays.

Tests may include:

Video Laryngostroboscopy – A simple look at the lower throat with a non-painful endoscope. This requires no anesthesia and will usually be done at an initial ENT visit for swallowing problems. It is helpful to diagnose problems occurring in the first stages of swallowing, and it is also used to identify signs of gastroesophageal reflux harming the throat – a common cause of swallowing problems.
A Barium Swallow Study

A motility study, which records movement and pressures of the esophagus
X-rays of the neck, head or thyroid
Twenty-four-hour pH test to determine the amount of acid reflux
Endoscopy to view the inside of the esophagus

Treatment

Sometimes just learning different physical techniques is enough to improve swallowing ability. Other times, and depending on the precise ailment, medical intervention, and/or surgery may be needed.

There are various strategies that are used to offer patients a more comfortable eating and swallowing experience. It is important to note that a swallowing therapist can tailor strategies to specific situations.

Some medications can do the following:

Reduce stomach acid
Overcome spasms of the esophagus
Help the swallowing nerves function better

Surgery:

Surgery also may be an option for people with swallowing disorders. Surgical treatments depend on the location of the swallowing disorder and may involve strengthening or loosening the upper or lower esophageal valves or removing obstructions or tumors from the esophagus.