Memorial Hospital Answers Your Questions about Difficult and Painful Swallowing

Pam Honeycutt, a speech-language pathologist at Lake Charles Memorial Hospital, discusses dysphagia-difficult and often painful swallowing-that may prevent you from eating enough of the right foods to stay healthy or maintain an ideal weight.

Q.    What causes dysphagia?

A.    Dysphagia has many causes: Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson's disease, often have problems swallowing. Additionally, stroke or head injury may affect the coordination of the swallowing muscles or limit sensation in the mouth and throat. An infection or irritation can cause narrowing of the esophagus. People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with a hole in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle.

Cancer of the head, neck, or esophagus-or their treatments-may also cause swallowing problems, as can injuries of the head, neck, and chest.

Q.   Is dysphagia serious?

A.   It can be. In addition to making eating a challenge, sometimes food or liquid enters the windpipe of someone with dysphagia and coughing or throat clearing cannot remove it. Food or liquid that stays in the windpipe may enter the lungs and create a chance for harmful bacteria to grow. A serious infection (aspiration pneumonia) can result.

Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. Someone with this problem may draw undigested food into the pharynx while lying down or sleeping. The esophagus may be too narrow, causing food to stick, which may prevent other food or even liquids from entering the stomach.

Q.   How does dysphagia occur?

A.   Dysphagia occurs when there is a problem during any part of the swallowing process, a complex procedure that includes 50 pairs of muscles and numerous nerves working to move food from the mouth to the stomach. If we were to analyze the swallowing process, we'd recognize three distinct stages. First, the tongue moves food around in the mouth for chewing, which makes the food the right size to swallow, and helps mix the food with saliva. Saliva softens and moistens the food to make swallowing easier, and the tongue collects the prepared food or liquid, making it ready for swallowing.

The second stage begins when the tongue pushes the food or liquid to the back of the mouth, which triggers a swallowing reflex that passes the food through the pharynx (the canal that connects the mouth with the esophagus). During this stage, the larynx (voice box) closes tightly and breathing stops to prevent any food or liquid from entering the lungs.

During the third stage food or liquid enters the esophagus, which is the canal that connects the pharynx to the stomach.

With dysphagia, weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing. Food pieces that are too large for swallowing may enter the throat and block the passage of air.

Other problems include not being able to start the swallowing reflex (a stimulus that allows food and liquids to move safely through the pharynx) because of a stroke or other nervous system disorder. People with these kinds of problems are unable to begin the muscle movements that allow food to move from the mouth to the stomach. Another difficulty can occur when weak throat muscles cannot move all of the food toward the stomach. Bits of food can fall or be pulled into the windpipe (trachea), which may result in lung infection.

Q.   How is dysphagia treated?

A.   There are different treatments for various types of dysphagia. First, doctors and speech-language pathologists who test for and treat swallowing disorders use a variety of tests that allow them to look at the parts of the swallowing mechanism. One test, called a fiber optic laryngoscopy, allows the doctor to look down the throat with a lighted tube. Other tests, including fluoroscopy, allow careful analysis and recordings of the dynamics of a patient's swallowing.

Once the cause of the dysphagia is found, surgery or medication may help. If treating the cause of the dysphagia does not help, the doctor may have the patient see a speech-language pathologist who is specially trained in testing and treating swallowing disorders. The speech-language pathologist will test the person's ability to eat and drink and may teach the person new ways to swallow more safely.

Treatment may involve muscle exercises to strengthen weak facial and throat muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help others. For instance, those who cannot swallow liquids may need to add special thickeners to their drinks. Others may have to avoid hot or cold foods or drinks.

Unfortunately, consuming foods and liquids by mouth may no longer be possible for some. These individuals must use other methods for nourishment, which may involve a feeding system, such as a feeding tube, that bypasses the part of the swallowing mechanism that is not working normally.

Q.   What research is being done on dysphagia?

A.   Scientists are conducting research that will improve the ability of physicians and speech-language pathologists to evaluate and treat swallowing disorders. All aspects of the swallowing process are being studied in people of all ages, including those who do and do not have dysphagia. For example, scientists have found that there is great variation in tongue movement during swallowing. Knowing which tongue movements cause problems will help physicians and speech-language pathologists evaluate swallowing.

Research has also led to new, safe ways to study tongue and throat movements during the swallowing process. These methods will help physician and speech pathologists safely reevaluate a patient's progress during treatment. Studies of treatment methods are helping scientists discover why some forms of treatment work with some people and not with others. For example, research has shown that, in most cases, a patient who has had a stroke should not drink with his or her head tipped back. New techniques, such as specific electrical stimulation, have been found to be effective in establishing safer swallowing in some patients. This knowledge and therapeutic techniques will help some patients avoid serious lung infections and help others avoid tube feedings.

Q.   Where can I get help?

A.   If you have a swallowing problem, your primary physician may refer you to an otolaryngologist, a physician with special training in disorders of the ear, nose, and throat, or a speech-language pathologist trained in dysphagia therapy. You may also be referred to a neurologist, and occupational and physical therapists if a stroke or other neurologic disorder causes the swallowing problem.

For more information, call Memorial's Team Therapy Rehabilitation at (337) 494-2556.