Difficulty in swallowing could be caused by a number of reasons, ranging from psychological problems such as anxiety or more physiological ones such as damage to a muscle or nerve involved in the swallowing process. However, when exactly does a problem in swallowing become a cause for concern? We find out more.
Swallowing problems are of medical concern when they become persistent and progressive. One should consider seeking medical attention early, especially when there are accompanying symptoms of pain during swallowing, regurgitation, vomiting, or coughing or when there is a presence of blood-stained phlegm, change in voice, shortness of breath, or weight loss.
Investigations and treatment options will depend on the cause.
Swallowing is a complex and coordinated process. There are three stages in swallowing: oral, pharyngeal, and oesophageal. Damage to any of the muscles and nerves involved in swallowing can lead to dysfunction in one of these stages.
For example, in the case of problems with tongue innervation affecting tongue movement, issues forming a proper bolus and problems with moving the bolus towards the oropharynx may arise.
If there is a dysfunction in the pharyngeal phase, food may penetrate the vocal folds and enter the airway, resulting in pneumonia.
During the oesophageal phase, stomach contents can be regurgitated into the oesophagus if the lower oesophageal sphincter does not stay contracted. This can cause inflammation of the oesophagus, leading to heartburn and reflux.
For patients with swallowing problems due to an underlying neurological, neurodegenerative, or muscular disorder, a comprehensive team of physicians, neurologists, speech therapists, and dietitians will be involved in managing these problems.
Swallowing assessments such as a videoflouroscopy or fibre-optic endoscopic evaluation of swallowing are common investigations performed to evaluate oropharyngeal dysphagia. These investigations will determine if one is able to safely consume food orally by testing swallowing with a range of food and fluid consistencies.
If a patient is deemed at risk of aspiration (food going into the airway), nasogastric tube feeding or a percutaneous endoscopic gastrostomy may be suggested. Swallowing exercises of the throat and neck may be introduced as well to aid swallowing. The use of endoscopic botulinum toxin injections may be suitable for some.
A large group of patients that I see typically describe their swallowing problems as sensing a foreign body in the throat or similarly feeling a lump when they swallow. This sensation is medically known as globus pharyngeus. The sensation commonly occurs due to acid reflux, pharyngitis, post-nasal drip, or having enlarged tonsils. A subset of patients may benefit from speech therapy or a course of proton pump inhibitors.
For patients with post-nasal drip, treatment options will involve a trial of antihistamines, intranasal steroidal sprays, and nasal douche. Allergy testing may be introduced for those who report symptoms of itchy, runny nose or with a background of atopy (relating to e.g., eczema, asthma). Nasal procedures may be suitable for some with persistent, recurrent symptoms despite the use of medications and allergen avoidance.
Acid reflux is a common condition and is medically termed laryngopharyngeal reflux if symptoms occur only in the throat. Contributing factors include a stressful lifestyle, anxiety, smoking, or a diet high in caffeine, alcohol, and spices.
General medical advice that can help ease globus is to avoid the above risk factors, ensure adequate hydration, rest, and maintain a healthy body weight within an appropriate BMI range.
Lastly, dysphagia may be a symptom of underlying head and neck malignancy. Smoking, betel nut chewing, alcohol consumption, and human papillomavirus (HPV) type 16 infection are known risk factors. Early medical atten
