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:
- The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
- During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
- 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.
- 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 or Dr. Bailor. Either 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.