A Deep Dive Into Complications, Symptoms, and Treatment
- What symptoms commonly accompany swallowing disorders?
- How do doctors diagnose swallowing disorders?
- How is the condition usually treated?
- And more…
Swallowing difficulties, medically termed dysphagia, are prevalent across all age brackets, particularly among older individuals. Dysphagia is a term used to describe the sensation of having trouble moving food or liquids from the mouth to the stomach. Various factors can trigger this condition, but most are temporary, so they should not be cause for alarm. It's infrequent for swallowing difficulties to indicate a more severe ailment, such as certain neurological disorders or tumors. However, if the issue persists beyond a brief duration, it is important to consult with a head and neck specialist surgeon (otolaryngologist) to explore treatment options.
How do we swallow?
The average person swallows hundreds of times in any given day, whether it’s consuming foods or liquids, or just the natural mucus and saliva production in the body. The act of swallowing encompasses four interconnected phases:
- The initial phase is called the oral preparation stage, where liquid and food undergo manipulation and chewing to make them ready to be swallowed.
- The next phase is the oral stage, during which the tongue forces the liquids or food towards the rear of the mouth, triggering the swallowing reflex.
- The third phase is the pharyngeal stage, commencing as liquid or food swiftly traverses the pharynx, the throat region linking the mouth and the esophagus. It then proceeds to the esophagus, commonly referred to as the swallowing tube.
- During the final stage of the process, liquids and foods transition from the esophagus to the stomach.
While the initial two phases involve some conscious control, the third and fourth stages occur automatically, without the need for conscious intervention.
What symptoms commonly accompany swallowing disorders?
For patients in Novi Swallowing Disorder symptoms may include:
- discomfort or pain in the chest or throat area (when experiencing gastroesophageal reflux)
- drooling
- weight management or nutrition difficulties due to long-term or significant difficulty with swallowing
- a feeling of liquid or food sticking to the throat passage
- choking or coughing due to small quantities of food, saliva, or liquids not passing smoothly during the swallowing process, which can then become inhaled into the lungs
- feeling like there is a “lump” or foreign object lodged in your throat
- voice changes
Retrograde Cricopharyngeal Dysfunction (RCPD)
Though technically not a swallowing disorder, retrograde cricopharyngeal dysfunction (RCPD) is another condition affecting the esophageal area that can cause uncomfortable symptoms. Also known as no burp syndrome, RCPD makes it impossible for an individual to release air from the stomach or esophagus. Burping is a normal biological function in which the cricopharyngeus muscle on top of the esophagus opens to let air exit the body via the mouth or the nose. In people with retrograde cricopharyngeal dysfunction (RCPD), this muscle does not relax, and the air becomes trapped in the body, causing symptoms like bloating, gurgling sounds, and excessive flatulence.
One common treatment involves injecting Botox into the cricopharyngeal muscle to help it relax, which typically provides excellent results. In cases where Botox does not treat the symptoms of RCPD, a minimally invasive surgery known as partial myotomy of the cricopharyngeus muscle may be performed to help the muscle relax.
How do we diagnose swallowing disorders?
To begin, people who are faced with a persistent Swallowing Disorder such as dysphagia are seen in a consultation with the head and neck specialist who will review the medical history and conduct an examination of the oral and throat regions. In some cases, mirrors may be employed for this examination. Occasionally, a narrow tube known as a flexible laryngoscope may be inserted into the nose, allowing the patient to consume food while the device remains within the throat. The two most-used assessments are FEES, or Fiber optic Endoscopic Evaluation of Swallowing, and FEESST, a Flexible Endoscopic Evaluation of Swallowing with Sensory Testing, making it possible to visually inspect the throat, tongue, and larynx in action. If deemed necessary, the otolaryngologist may also examine the esophagus, known as TNE, or TransNasal Esophagoscopy. Seeking treatment for swallowing difficulties is crucial to prevent dehydration and malnutrition.
How do we treat swallowing disorders?
Swallowing disorders often have various treatment options. Medications can be effective in managing many of the conditions. There are medications available, such as those that reduce stomach acid, antacids, and muscle relaxants. Treatment is customized to address the specific underlying causes of that patient’s swallowing disorder. For individuals with gastroesophageal reflux, adopting certain lifestyle changes can be beneficial, including:
- Eliminating alcohol, caffeine, and tobacco consumption.
- Managing stress and weight levels.
- Avoiding food intake at least three hours before bed.
- Elevating the head at night while sleeping.
- Switching to a simpler, less intense diet with more frequent, smaller meals.
If trouble or discomfort persists, you can take antacids after meals or before bed may offer relief. In some cases, direct Swallowing Disorder Treatments can be beneficial for Novi patients with swallowing disorders. A specialist in speech pathology can bring specialized exercises to stimulate the muscles and nerves responsible for the swallowing reflex. Patients can also utilize techniques for managing food placement within the mouth and optimizing the positioning of the head and body to help with effective swallowing. Individuals who struggle with self-feeding due to swallowing disorders can receive assistance from an occupational therapist or speech-language pathologist, empowering them to achieve greater independence.
A dietitian or nutrition expert can assess the nutritional needs of the individual, determining the appropriate liquid or food intake and the potential need for supplements. When the cause of the swallowing disorder has been identified, treatment options may include:
- Medications.
- Swallowing therapies.
- Surgical procedures.
Surgical intervention is reserved for specific conditions. If there is a constriction in the esophagus or throat, it may be necessary to perform a stretching or dilation procedure in that area. For muscles that are excessively tight, surgical dilation or release, known as a myotomy, may be recommended. The procedure is conducted by an otolaryngologist—neck and head specialist surgeon. Many illnesses can become contributing factors to the development of swallowing disorders. Individuals experiencing persistent difficulties should seek consultation with an otolaryngologist.
Functional Endoscopic Evaluation of Swallow (FEES)
A Functional Endoscopic Evaluation of Swallow, or FEES, is a diagnostic procedure to help identify the causes of the dysphagia (difficulty swallowing). A narrow endoscope with a tiny camera on the end is passed through the nose in order to provide a view into the throat. You will swallow with and without eating while your provider observes various mechanisms to identify which structures may be causing problems. This information is used to develop a treatment plan to improve swallowing function, which may include dietary changes, swallowing therapy, or surgery.
Transnasal Esophagoscopy (TNE)
Transnasal esophagoscopy (TNE) is a minimally invasive diagnostic procedure to examine the esophagus. A thin, flexible endoscope is guided through the nasal passages and into the esophagus. This allows for visual inspection of the esophageal lining, assessment of any abnormalities, and the ability to obtain tissue samples (biopsies) if necessary. TNE is commonly used to evaluate conditions such as acid reflux, esophagitis, strictures, and Barrett's esophagus. Because it doesn't require sedation or throat numbing, TNE is well-tolerated by patients and can be performed in an office setting.
Zenker's Diverticulectomy
Zenker's diverticulum, also known as pharyngoesophageal diverticulum, is a condition in which a pouch forms just above the upper esophageal sphincter. This pouch can protrude through a weak area in the wall of the esophagus and into the neck. The development of Zenker's diverticulum is often associated with problems in the coordination of the muscles involved in swallowing. The condition is more common in older adults and causes symptoms including difficulty swallowing, regurgitation of undigested food, coughing, bad breath, and sometimes weight loss.
Zenker's diverticulectomy is a surgical procedure performed to treat Zenker's diverticulum. Your provider accesses the esophagus either through open surgery or endoscopy in order to excise or remove the diverticulum, providing symptom relief. In some cases, the procedure may also involve repairing any associated muscle abnormalities of the throat.
What are the causes of swallowing disorders?
Disruptions in the natural swallowing process may lead to swallowing difficulties. Slower eating and thorough chewing can be beneficial in minimizing swallowing difficulties. However, problems may arise from a variety of factors, including seemingly minor issues like dental problems, poorly fitted dentures, or even an illness like a cold. One prevalent cause for dysphagia is gastroesophageal reflux, where stomach acid is moving upward into the esophagus and throat, resulting in discomfort. Additional contributing factors may encompass:
- Hypertension.
- Diabetes.
- Thyroid disorders.
- Stroke.
- Progressive neurological conditions.
- The presence of a tracheotomy tube.
- Vocal cord paralysis or immobility.
- Tumors in the esophagus, throat, or mouth.
- Surgical interventions in the neck, head, or esophageal regions.
Some medications can also have a connection with swallowing difficulties, including:
- Aspirin.
- Nitrates.
- Calcium channel blockers.
- Vitamin C.
- Calcium tablets.
- Tetracycline, often used for acne treatment.
- Iron supplements.
- Antipsychotic medications.
- Anticholinergic agents, which are present in select antidepressants and medications for allergy.
For further information regarding treatments for swallowing disorders in Novi, individuals can contact us at (248) 477 7020 to schedule a consultation.
