Difficulty Swallowing (Dysphagia)

Dysphagia means that liquid or solid food takes longer, or becomes difficult, to pass from the mouth to the stomach. In some conditions swallowing is painful. In advanced cases the patient can swallow nothing at all.

Dysphagia happens at every age, and it becomes commoner as people get older.

What causes it

The cause can be a loss of sensation or of movement in the organs and tissues involved in swallowing. It can also be cognitive or psychological in origin.

Neurological problems. Diseases that affect the central or the peripheral nervous system supplying the structures used in swallowing cause it:

• Head injury and injury to the head and neck
• Bleeding in the brain, a clot travelling to the brain, and vascular disease of the brain and spinal cord
• Long-standing or progressive neurological disease, such as Parkinson’s disease, myasthenia gravis, muscular dystrophy and cerebral palsy

Anatomy and tumours of the head and neck. Cleft palate, cleft lip, and cancer of the back of the nose, the face, the mouth, the throat, the larynx, the pharynx, the gullet and the windpipe.

Other conditions. Systemic rheumatic and inflammatory disease, and surgery in the head and neck region.

What it does to daily life

Swallowing problems lower quality of life and cause social problems. The patient cannot eat where and how they want, and eats without pleasure, so they become unhappy and anxious. Both socially and psychologically the effect is heavy. If only food of a certain consistency can be taken, finding or preparing it becomes a problem in itself.

How swallowing is assessed

The assessment always follows a detailed history and a full ear, nose, throat, head and neck examination. There are two main methods, one radiological and one endoscopic.

Radiological assessment. A contrast medium is added to the food. While the patient eats and swallows, the working of the swallowing organs is examined in real time with X-rays. It is called the modified barium swallow.

Endoscopic assessment. This is done in the clinic, with no anaesthesia and no special preparation. A flexible endoscope shows the organs directly while the patient eats and swallows. It shows how the food is pushed into the pharynx, whether anything goes wrong on the way to the gullet, and whether anything leaks between the vocal cords into the windpipe.

Treatment

The aim is to keep every organ that takes part in swallowing working as well as possible. That means keeping breathing, making sound, speaking, swallowing and protecting the airway going, so that nothing passes into the lungs. A swallowing therapy plan is designed and applied for each patient.

When to see a doctor

See an ear, nose and throat specialist for a swallowing assessment if

• you have a swallowing problem that does not go away
• you are losing weight without meaning to and with no reason for it
• you cough repeatedly during or after eating, or you belch or vomit heavily
• something stops you breathing
• you feel that something is stuck in your throat, or that something is there