What is Dysphagia?

What is Dysphagia?

Difficulty in swallowing (dysphagia) is common among all age groups, it is estimated to be 22.6% of the general population. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are not threatening and temporary.  Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself, in a short period of time, you should see an otolaryngologist-head and neck surgeon.

How do we swallow?
People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four related stages:
The first stage is the oral preparation stage, where food or liquid is manipulated and chewed in preparation for swallowing.

The second stage is the oral stage, where the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.

The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynx, the region of the throat which connects the mouth with the esophagus, then into the esophagus or swallowing tube.

In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.
Although the first and second stages have some voluntary control, stages three and four occur involuntarily, without conscious input.

What causes swallowing disorders?
Any interruption in the swallowing process can cause difficulties.  Eating slowly and chewing thoroughly can help reduce problems with swallowing.  However, difficulties may be due to a range of other causes, including something as simple as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastro esophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort.  Other causes may include: hypertension; diabetes; thyroid disease;  stroke;  progressive neurologic disorder;  the presence of a tracheotomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

Swallowing difficulty can also be connected to some medications including:

• Nitrates
• Anticholinergic agents found in certain anti-depressants and allergy medications
• Calcium tablets
• Calcium channel blockers
• Aspirin
• Iron tablets
• Vitamin C
• Antipsychotic
• Tetracycline (used to treat acne)

What are the symptoms of swallowing disorders?
Symptoms of swallowing disorders may include:

• drooling
• a feeling that food or liquid is sticking in the throat
• discomfort  in  the  throat  or  chest  (when gastroesophageal reflux is present)
• a sensation of a foreign body or "lump" in the throat
• weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing,  and coughing or choking caused by bits of food,  liquid,  or saliva not passing easily during swallowing,  and being sucked into the lungs.
• voice change

How are swallowing disorders diagnosed?
When dysphagia is persistent and the cause is not apparent, the otolaryngologist—head and neck surgeon will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors.  Sometimes a small tube (flexible laryngoscope) is placed through the nose and the patient is then given food to eat while the scope is in place in the throat. These procedures provide visualization of the back of the tongue, throat,
and larynx (voice box). These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing).  If necessary, an examination of the esophagus, named TransNasal Esophagoscopy (TNE), may be carried out by the otolaryngologist.  If you experience difficulty swallowing, it is important to seek treatment to avoid malnutrition and dehydration.

How are swallowing disorders treated?
Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder.

• Eat a bland diet with smaller, more frequent meals.
• Eliminate tobacco, alcohol and caffeine.
• Reduce weight and stress.
• Avoid food within three hours of bedtime.
• Elevate the head of the bed at night.

If these don't help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselves.  An occupational therapist or a speech language pathologist can aid the patient and family in feeding techniques.  These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary. Once the cause is determined, swallowing disorders may be treated with:

• medication
• swallowing therapy
• surgery

Surgery is used to treat certain problems. If a narrowing exists in the throat or esophagus, the area may need to be stretched or dilated.  If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist—head and neck surgeon.

Many diseases contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist—head and neck surgeon.

Services Offered at Medical City
Flexible Endoscopic Evaluation of Swallowing (FEES)
A standard technique for evaluating patients with swallowing problems. A flexible scope is passed transnasally to the patient's hypopharynx to view laryngeal & pharyngeal structures.   Clinician then observes swallowing function by feeding the patient various bolus consistencies and amount of food.  It provides real-time display of swallowing function and is recorded for subsequent review.

FEES with Sensory Testing (FEEST)
Swallow evaluation with sensory testing is the only procedure that allows both sensory & motor aspects of swallowing . A sheath with port for air pulse delivery is slide into a flexible scope prior to its insertion into the nose.   Calibrated air pulses are then delivered endoscopically to stimulate areas of the larynx.    Sensory discriminating threshold is quantitatively measured while observing laryngeal adductor (closure) reflex.

Swallowing Rehabilitation Program
Patients with swallowing problems as a result of stroke & other neurological conditions are given exercises for coordinating the swallowing muscles or re-stimulating he nerves that trigger the swallow reflex Strategies to facilitate swallow & safe feeding are also carried out.

Portions reprinted from a patient leaflet of the American Academy of Otolaryngology- Head and Neck Surgery Foundation

How Can The Medical City Help You?
At The Medical City we have a complete roster of competent Otolaryngologists who may assess or treat people with
swallowing problems.

Note:  This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.    If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

 For further inquiries or if you want to seek consult, please call:

CENTER FOR VOICE AND SWALLOWING DISORDERS
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6251 / (632) 689-8201 (direct line)

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444