What does dysphagia really feel like?
Its description of “difficulty swallowing” may seem simple, but dysphagia can mean different things for different people. Here are some examples of commonly reported sensations:
- Pain while swallowing
- Inability to swallow
- Food getting stuck in throat or chest
- Coughing or gagging when trying to eat or drink
Who is affected by dysphagia?
Occasional difficulty swallowing can happen to anyone and is not a cause for major concern. However, persistent difficulty swallowing that noticeably impacts your comfort level could indicate a medical issue.
Dysphagia is associated with several different diseases and medical conditions. Some examples are listed below:
- Cancers and benign tumors of the thyroid, head and neck, or gastrointestinal system
- Post-operative complications after thyroid, head and neck, spine, or gastrointestinal surgery
- Stroke and other neurological events affecting the nerves involved in swallowing
- GERD, also known as acid reflux
- Blunt trauma, burns, or other injury to the head and neck region, including spinal cord
What causes dysphagia?
The process of swallowing is highly complex and involves multiple cranial nerves for sensory input and motor output and close coordination of many muscles involved in the voluntary and involuntary components of the swallow. As a result, there are many
steps in which something can go wrong. The different causes are separated into four broad categories:
- Oropharyngeal dysphagia – due to an anatomic or neurophysiologic impairment in the muscle function within the oral cavity, pharynx, larynx or upper esophagus
- Esophageal / obstructive dysphagia – due to blockage or malfunction of the esophagus
- Neuromuscular symptom complex – due to cortical damage, as in stroke or brain injury
- Functional dysphagia (i.e., globus) – due to an otherwise unidentifiable cause
What kind of specialist should I see about my symptoms?
If you have persistent difficulty swallowing that noticeably impacts your comfort, especially while eating or drinking, then it is a good idea to make a doctor’s appointment. Your primary doctor is a good place to start. He or she may refer you to an otolaryngologist (commonly known as ENT), gastroenterologist, radiologist, or another specialist. If your symptoms have developed after a surgical procedure, you should notify and consult with your surgeon. You may also seek treatment from or be referred to a speech-language pathologist with expertise in dysphagia, known as a Board Certified Specialist in Swallowing and Swallowing Disorders. These are speech-language pathologists with extensive training independently and provide high-quality clinical services to patients. They are a valuable resource and can be recognized by the degree notation CCC-SLP, BCS-S.
What kind of tests are performed to diagnose dysphagia?
Here are some examples of common tests to diagnose and determine the cause of dysphagia:
- Modified Barium Swallow (MBS) study – patient drinks and eats a substance, barium, that is visible on X-ray scans; allows a speech pathologist and radiologist to visualize the actual path of food and liquid through the mouth, pharynx and esophagus in real time, and detect any anatomic or neuromuscular abnormalities. Once identified, the speech-language pathologist can attempt therapeutic strategies to try to make the swallow safer and/or more efficient
- Flexible endoscopic Evaluation of Swallowing (FEES) – a thin endoscope with a camera on the tip that is passed through the nose into the pharynx to view the swallow mechanism while color-tinged foods and liquids are swallowed. The FEES exam also examines the effects of rehabilitation strategies on swallow functioning.
- Esophageal endoscopy – a thin rigid or flexible scope is passed through the esophagus to visualize the anatomy
- Manometry – a thin tube with pressure sensors is passed through the pharynx into the esophagus to measure the timing and strength of muscle contractions within the esophagus
- Imaging – CT, MRI, and PET scans can be useful to visualize the mouth, neck, and chest for any anatomical abnormalities
What are my treatment options?
Choosing a treatment for dysphagia depends on the underlying cause. Your doctor should discuss both surgical and non-surgical treatment options based on your individual symptoms and needs.
Non-surgical treatment options:
- Rehabilitation exercises and swallow maneuvers, with a speech language pathologist, who specializes in swallowing disorders, – designed to improve the timing, range, coordination and strength of the muscles responsible for swallowing
- Compensatory swallowing strategies – designed to modify food volume and texture and head positioning for improved flow of food and liquids to optimize safety and efficiency
- Lifestyle modifications – avoiding certain foods, adjusting diet to include softened or thickened foods.
- Medication – prescription medication to reduce stomach acid can be helpful
Surgical treatment options:
- Esophageal dilation – a procedure in which the esophagus is gently stretched and widened to allow easier passage of food and liquids
- Surgical removal of tissues that have become narrowed after radiotherapy and reconstruction with tissue from another part of the body
- Tumor resection – the removal of any tumor affecting swallowing, benign or malignant
- Feeding tube – installed to bypass the upper swallowing pathway altogether only in the most severe cases of dysphagia
Frequently Asked Questions about Dysphagia