Dysphagia - problems eating and swallowing

Dysphagia definition – what is dysphagia?

The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach – including eating disorders and problems eating and swallowing and problems drinking
Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly
This may be caused by many factors, most of which are temporary and not threatening
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 ENT – head and neck surgeon

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 oesophagus, then into the oesophagus or gullet
- In the final, oesophageal stage, the food or liquid passes through the oesophagus into the stomach
Although the first and second stages have some voluntary control, stages three and four occur involuntarily, without conscious input

When dysphagia is persistent and the cause is not apparent, the ENT – head and neck surgeon will discuss the history of your problem and examine your mouth and throat
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) and are performed together with a speech pathologist
If necessary, an examination of the oesophagus, named TransNasal Oesophagoscopy may be carried out by the otolaryngologist
If you experience difficulty swallowing, it is important to seek treatment to avoid malnutrition and dehydration

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
Gastro oesophageal reflux can often be treated by changing eating and living habits in these ways:
- 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

Medication
Therapy by a speech pathologist
Surgery
- Surgery is used to treat specific problems
- If a narrowing exists in the throat or oesophagus, 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 ENT – head and neck surgeon

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 oesophageal reflux
This occurs when stomach acid moves up the oesophagus 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 oesophagus; or surgery in the head, neck, or oesophageal 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)

Many diseases contribute to problems with eating and drinking
If you have a persistent problem with eating and drinking, see your Ear Nose Throat Specialist – head and neck surgeon for appropriate evaluation and treatment