Swallowing difficulty is the inability to swallow foods or liquids with ease. People who have a hard time swallowing may choke on their food or liquid when trying to swallow. Dysphagia is a another medical name for difficulty swallowing. This symptom isn’t always indicative of a medical condition. In fact, this condition may be temporary and go away on its own.
What causes
swallowing difficulty?
According to the National Institute on Deafness and Other Communication Disorders, there are 50 pairs of muscles and nerves used to help you swallow. In other words, there are lots of things that can go wrong and lead to problems swallowing. Some conditions include:
- Acid reflux and GERD: Acid reflux symptoms are caused when stomach contents flow up from the stomach back into the esophagus, causing symptoms like heartburn, stomach pain, and burping. Learn more the causes, symptoms, and treatment of acid reflux and GERD.
- Heartburn: Heartburn is a burning sensation in your chest that often occurs with a bitter taste in your throat or mouth. Find out how to recognize, treat, and prevent heartburn.
- Epiglottitis: Epiglottitis is characterized by inflamed tissue in your epiglottis. It's a potentially life-threatening condition. Learn who gets it, why, and how it's treated. This condition is considered a medical emergency. Urgent care may be required.
- Goiter: Your thyroid is a gland found in your neck just below your Adam's apple. A condition that increases the size of your thyroid is called a goiter. Read more about the causes and symptoms of goiter.
- Esophagitis: Esophagitis is inflammation of the esophagus that can be caused by acid reflux or certain medications. Learn more about the types of esophagitis and their treatments.
- Esophageal cancer: Esophageal cancer occurs when a malignant (cancerous) tumor forms in the lining of the esophagus, which can cause difficulty swallowing. Read more about esophageal cancer, its causes, diagnosis, and treatment.
- Stomach cancer (gastric adenocarcinoma): Stomach cancer occurs when cancerous cells form in the stomach lining. Because it's difficult to detect, it's often not diagnosed until it's more advanced. Learn about the symptoms, diagnosis, treatment, and prognosis of stomach cancer.
- Herpes esophagitis: Herpes esophagitis is caused by the herpes simplex virus type 1 (HSV-1). The infection can cause some chest pain and difficulty swallowing. Learn more about how herpes esophagitis is diagnosed and treated.
- Recurrent herpes simplex labialis: Recurrent herpes simplex labialis, also known as oral or orolabial herpes, is an infection of the mouth area caused by the herpes simplex virus. Read about symptoms, treatment, and prevention of this infection.
- Thyroid nodule: A thyroid nodule is a lump that can develop in your thyroid gland. It can be solid or filled with fluid. You can have a single nodule or a cluster of nodules. Learn what causes thyroid nodules and how they are treated.
- Infectious mononucleosis: Infectious mononucleosis, or mono, refers to a group of symptoms usually caused by the Epstein-Barr virus (EBV). Learn about the symptoms and treatments for infectious mononucleosis.
- Snake bites: A bite from a venomous snake should always be treated as a medical emergency. Even a bite from a harmless snake can lead to an allergic reaction or infection. Read more about what to do in the event of a snake bite.
Types of dysphagia
Swallowing occurs in four phases: oral preparatory, oral, pharyngeal, and esophageal. Swallowing difficulty can be broken down into two categories: oropharyngeal (which includes the first three phases) and esophageal.
Oropharyngeal
Oropharyngeal dysphagia is caused by disorders of the nerves and muscles in the throat. These disorders weaken the muscles, making it difficult for a person to swallow without choking or gagging. The causes of oropharyngeal dysphagia are conditions that primarily affect the nervous system such as:
- multiple sclerosis
- Parkinson’s disease
- nerve damage from surgery or radiation therapy
- post-polio syndrome
Oropharyngeal dysphagia can also be caused by esophageal cancer and head or neck cancer. It may be caused by an obstruction in the upper throat, pharynx, or pharyngeal pouches that collect food.
Esophageal
Esophageal dysphagia is the feeling that something is stuck in your throat. This condition is caused by:
- spasms in the lower esophagus, such as diffuse spasms or the inability of the esophageal sphincter to relax
- tightness in the lower esophagus due to an intermittent narrowing of the esophageal ring
- narrowing of the esophagus from growths or scarring
- foreign bodies lodged in the esophagus or throat
- a swelling or narrowing of the esophagus from inflammation or GERD
- scar tissue in the esophagus due to chronic inflammation or post-radiation treatment
Identifying
dysphagia
If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.
They include:
- drooling
- a hoarse voice
- feeling that something is lodged in the throat
- regurgitation
- unexpected weight loss
- heartburn
- coughing or choking when swallowing
- pain when swallowing
- difficulty chewing solid foods
These sensations may cause a person to avoid eating, skip meals, or lose their appetite.
Children who have difficulty swallowing when eating may:
- refuse to eat certain foods
- have food or liquid leaking from their mouths
- regurgitate during meals
- have trouble breathing when eating
- lose weight without trying
How is swallowing
difficulty diagnosed?
Talk to your doctor about your symptoms and when they began. Your doctor will do a physical examination and look in your oral cavity to check for abnormalities or swelling.
More specialized tests may be needed to find the exact cause.
Barium X-ray
A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you will swallow liquid or a pill containing a dye that shows up on an abdominal X-ray. The doctor will look at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This will help identify any weaknesses or abnormalities.
A videofluorscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of the swallow. During this examination, you’ll swallow a variety of consistencies ranging from purees to solids and thin and thickened liquid. This will help the doctor detect the ingestion of food and liquid into the trachea. They can use this information to diagnose muscle weakness and dysfunction.
Endoscopy
An endoscopy may be used to check all areas of your esophagus. During this examination, the doctor will insert a very thin flexible tube with a camera attachment down into your esophagus. This allows the doctor to see the esophagus in detail.
Manometry
The manometry is another invasive test that can be used to check the inside of your throat. More specifically, this test checks the pressure of the muscles in your throat when you swallow. The doctor will insert a tube into your esophagus to measure the pressure in your muscles when they contract.
Treating swallowing
difficulty
Some swallowing difficulties can’t be prevented and dysphagia treatment is necessary. A speech-language pathologist will perform a swallowing evaluation to diagnosis your dysphagia. Once the evaluation is completed, the speech pathologist may recommend:
- diet modification
- oropharyngeal swallowing exercises to strengthen muscles
- compensatory swallowing strategies
- postural modifications that you should follow while eating
However, if swallowing problems are persistent, they can result in malnutrition and dehydration, especially in the very young and in older adults. Recurrent respiratory infections and aspiration pneumonia are also likely. All of these complications are serious and life-threatening and must be treated definitively.
If your swallowing problem is caused by a tightened esophagus, a procedure called esophageal dilation may be used to expand the esophagus. During this procedure, a small balloon is placed into the esophagus to widen it. The balloon is then removed.
If there are any abnormal growths in the esophagus, surgery may be necessary to remove them. Surgery may also be used to remove scar tissue.
If you have acid reflux or ulcers, you may be given prescription medication to treat them and encouraged to follow a reflux diet.
In severe cases, you may be admitted to the hospital and given food through a feeding tube. This special tube goes right into the stomach and bypasses the esophagus. Modified diets may also be necessary until the swallowing difficulty improves. This prevents dehydration and malnutrition.