Throat


Swallowing Problems

Difficulty in swallowing (dysphagia) is common among all age groups but especially so in the elderly. 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 (e.g. Lou Gehrig’s disease, Parkinson’s disease, cerebral palsy). Swallowing disorders may be a herald of more severe problems that may lead to aspiration pneumonia (saliva, food or liquid getting into the lungs). When the difficulty does not clear up within a short period of time one should see an ear, nose and throat physician.

How does swallowing work?

People normally swallow hundreds of times a day to eat solids and drink liquids and they also swallow the normal saliva and mucus that the body produces. The process of swallowing has four stages:

  1. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
  2. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
  3. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx (the canal that connects the mouth with the esophagus) into the esophagus or swallowing tube.
  4. 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 by themselves, without conscious input.

What causes swallowing disorders?

Any interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, ill-fitting dentures or a common cold. One of the most common causes of dysphagia is gastro-esophageal reflux (GERD). This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort.

Other causes may include: stroke, progressive neurologic disorder, the presence of a tracheostomy tube, a paralyzed or unmoving vocal cord, a tumor in the mouth, throat or esophagus, etc.

Who evaluates and treats swallowing disorders?

When dysphagia is persistent and the cause is not apparent, a good starting point would be to see Dr. Lieberman. He will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides a visual of the back of the tongue, throat and larynx (voice box). If necessary, he may recommend an examination of the esophagus, stomach and upper small intestine (duodenum) by a gastroenterologist.

Depending on the type of swallowing disorder, changing a person’s diet by adding thickeners may help alleviate the problem in a non-invasive manner. Sometimes drug therapy helps to relieve symptoms of an underlying neurological cause.


Head and Neck Cancer

TRACHEOSTOMY

Head and neck cancers encompass several different diseases that can affect the mouth, nose, throat and other surrounding areas. Over 50,000 Americans are diagnosed with head and neck cancer each year, as these diseases account for 3 to 5% of all cancers. Many cases of head and neck cancer can be prevented through life changes.

Several different types of cancer can affect the areas of the head and neck. Most begin in the lining of moist, mucosal surfaces such as the mouth, nose and throat. The cells in the lining are known as squamous cells, and may therefore be affected by squamous cell carcinomas. The different types of cancer associated with the head and neck include:

  • Oral cavity
  • Salivary glands
  • Nasal cavity
  • Pharynx
  • Larynx
  • Lymph nodes

Like other types of cancer, these diseases can spread to other areas of the body and lead to serious complications. Prompt, thorough treatment is essential in restoring the health and overall well-being of patients with head and neck cancer.

What are causes of head & neck cancer?

Head and neck cancers are most often caused by tobacco and alcohol use, especially cancer of the oral cavity and larynx (voice box). Other factors that may lead to cancer include sun exposure, HPV (human papilloma virus) and radiation exposure. Tobacco use is linked to 85% of head and neck cancers.

Many of these factors can be reduced or eliminated through simple lifestyle changes. Quitting smoking and avoiding alcohol can reduce your risk of developing head and neck cancer or slow the disease from progressing further. Patients who are at an increased risk for developing head and neck cancer should be screened regularly to detect any problems as quickly as possible. Early detection can significantly improve the effectiveness of treatment.

What are symptoms of head & neck cancer?

Fortunately, many people with head and neck cancers experience symptoms right away that lead to an early diagnosis of the condition. Symptoms of head and neck cancers vary depending on the type of cancer, but may include:

  • Lump in the neck
  • Hoarseness or other change in the voice
  • Growth in the mouth
  • Blood in saliva
  • Earache
  • New or changed growths on skin
  • Difficulty swallowing

While these issues may be caused by many conditions, it is important for patients to seek prompt medical attention at the first sign of these symptoms.

How is head & neck cancer diagnosed?

If a patient is experiencing any of these symptoms, Dr. Lieberman will perform a complete physical exam. Based on his observations, he might schedule an endoscopy procedure to examine the area in question and take a tissue sample to determine the exact nature of the problem. Often he orders imaging studies to help pinpoint the diagnosis (e.g. X-ray, CT scan, MRI).

If cancer has been diagnosed, it is important to determine the stage of the disease and whether or not it has spread to other areas of the body. Staging usually involves imaging procedures and can help determine the best
treatment approach for each individual patient.

What is the treatment for head & neck cancer?

Treatment for these cancers depends on the type and location of the tumor, as well as the patient's age and overall health. Treatment often includes surgery to remove the cancer, as well as chemotherapy and/or radiation therapy.

Surgery involves the removal of the cancerous tissue and some surrounding healthy tissue to ensure thorough eradication of the disease. Surgery may cause swelling and bruising and may affect the patient’s ability to chew, swallow or talk. Chemotherapy is often administered after surgery and uses medication to kill cancer cells over repeated treatment sessions. Similarly, radiation therapy uses high-energy x-rays to destroy cancer cells.

It is important to discuss treatment options with all of your physicians, as certain methods may have long-term effects on the way you look, talk, eat or breathe. Making healthy life changes, including avoiding smoking and alcohol use, will help prevent the disease from recurring, as well as reduce the risk for other diseases.