Swallowing Issues (Dysphagia)

True swallowing problems (Dysphagia) can be grouped into three categories:

  1. Oropharyngeal dysphagia
  2. Esophageal dysphagia
  3. Xerostomia is a third type of swallowing problem, albeit minor.

Oropharyngeal dysphagia

These swallowing problems happen before food reaches the esophagus and may result from neuromuscular disease or obstructions. Patients experience difficulty starting a swallow; food goes down the wrong pipe; or there is choking and coughing. This may result in poor nutrition or dehydration, aspiration (which can lead to pneumonia and chronic lung disease) or embarrassment in social situations that involve eating.1If the doctor suspects oropharyngeal dysphagia, testing will usually be coordinated by ENT doctors, neurologists or speech pathologists.

Symptoms of oropharyneal dysphagia may include2:

  • Coughing during or right after eating or drinking.
  • Extra effort or time needed to chew or swallow.
  • Food or liquid leaking from the mouth or getting stuck in the mouth.
  • Recurring pneumonia or chest congestion after eating.
  • Weight loss, dehydration and weakness from not being able to eat/drink enough.
  • A voice which sounds gurgling or wet during or after eating or drinking.

Esophageal dysphagia

These swallowing problems originate in the esophagus. Food or liquids “stick” in the chest or throat and sometimes come back up. Causes include esophageal cancer, esophagitis, gastroesphageal reflux disease (GERD) and esophageal-motility disorders.1If esophageal dysphagia is suspected, the doctor will look for a blockage or obstruction, irritations and motility problems where the esophagus is pumping too hard or not enough.2

Xerostomia (dry mouth)

The lessening or lack of saliva. Often, the first noticeable symptom of xerostomia is DIFFICULTY SWALLOWING. This is due to the loss of saliva as a LUBRICANT. Many people naturally adjust to this problem by drinking more fluids with meals. Their complaint to their physician or dentist might be that they are thirstier than usual or that they find that food does not have as much flavor or go down easily.3Home remedies for Xerostomia may include blending and moistening foods, sipping plain water and avoiding alcohol based mouth rinses. Biotene branded products can be purchased, over the counter, and are designed for dry mouth conditions. When home remedies prove unsuccessful, a prescription for Salgen may be required through a physician.3

The following tests may be used for a proper diagnosis2:

  • Esophagram (barium swallow). This X-ray with video capabilities views movement through the esophagus taken during a barium swallow; it’s usually the first test ordered for swallowing problems.
  • Endoscopy. An endoscope, a flexible, narrow tube, is passed into the esophagus and projects images of the inside of the pharynx and esophagus.
  • Esophageal manometry. A catheter is used to measure esophageal pressure and record the duration and sequence of contractions in the esophagus.
  • pH probes. Used to test for acid reflux.
  • Biopsy. Used to distinguish between GERD and eosinophilic esophagitis, an allergic, inflammatory reaction of the esophagus.
  • CT scans. Used to find tumors if esophageal cancer is suspected.

When one has a VS removed swallowing problems MAY occur if the facial nerve was involved. This may be because one doesn’t have amount of saliva needed and because the tongue doesn’t work the same as it once did.

If a VS tumor is allowed to grow large enough, it MAY involve other nerves such as the glossophayngeal nerve (CN IX – swallowing), hypoglossal nerve (CN XII – tongue), and vagus nerve (CN X – swallowing, cough).

All those nerves are all cramped together in a very tight spot. See Cranial Nerves diagram.

Aspiration during swallowing is often a big fear. One side usually remains functioning. However, the other side no longer does.

Some Minor Coping Strategies: (consult your physician)

  • Moist foods – such as soup, chili, yogurt, pudding, and/or stew are considered “safer” to eat.
  • Reduce solid food mechanically and mix with saliva (or substitute) to produce a pulverized consistency appropriate for swallowing.
  • Lateral rolling motion of the tongue to position food on the teeth during mastication.
  • Tilt head downwards (if possible) just before and during a swallowing attempt.

References:

1 Treatment of Swallowing Problems at Mayo Clinic

2 Dysphagia – Diagnosis at Mayo Clinic

3 Xerostomia – A Dry Subject

Further Readings: