Swallowing Disorders

Conditions that impair the functions of the muscles and nerves of the THROAT, interfering with the ability to swallow. The clinical term for this impairment is dysphagia. Swallowing disorders often exist with neuromuscular disorders such as AMYOTROPHIC LATERAL SCLEROSIS (ALS) and MUSCULAR DYSTROPHY, and as a consequence of damage to portions of the BRAIN resulting from STROKE or TRAUMATIC BRAIN INJURY (TBI). Dysphagia can affect any aspect of the swallowing process, from chewing to entry of the swallowed material into the STOMACH. Swallowing problems in young infants may indicate structural anomalies. Swallowing disorders are common among the elderly and in people of any age who have significant physical debility.

The symptoms of swallowing disorders may vary in severity and sometimes with circumstances. For example, dysphagia may manifest when the person is very tired or eats certain foods though not be apparent at other times. Symptoms may include

• SIALORRHEA (drooling)
• extended chewing because the food will not move to the back of the throat for swallowing
• difficulty initiating swallowing
• inability to swallow certain kinds of substances such as liquids
• frequent choking
• weight loss (secondary to inability to consume adequate calories)

The diagnostic path includes a careful health history and complete physical examination. Swallowing studies evaluate the coordination and control of muscles involved in moving food from the MOUTH to the stomach. A BARIUM SWALLOW X-ray, in which the person swallows a solution containing barium that coats the ESOPHAGUS, or videofluoroscopy can show irregularities in the passageway to the stomach. COMPUTED TOMOGRAPHY (CT) SCAN or MAGNETIC RESONANCE IMAGING (MRI) can provide added visualization of the throat and upper gastrointestinal tract. Laryngoscopy allows the doctor to examine the structures of the inside of the throat. The diagnostic path may also include a NEUROLOGIC EXAMINATION to determine the presence of conditions such as PARKINSON’S DISEASE that can affect the ability to swallow.

Treatment depends on the underlying cause. Sometimes medications to relax certain muscles or reduce the flow of saliva improve the functions of chewing and swallowing. Swallowing therapy (provided by a speech-language pathologist) can teach methods to strengthen muscles and improve coordination of the steps of swallowing as well as ways to prepare food and position it in the mouth for most effective swallowing. BIOFEEDBACK is helpful for some people. Surgery may be necessary to correct esophageal strictures that narrow the passageway for food.

Most people experience improvement with treatment, though swallowing disorders resulting from degenerative conditions such as Parkinson’s disease are likely to worsen as the disease progresses. In such situations, alternatives such as ENTERAL NUTRITION or PARENTERAL NUTRITION (supplemental or replacement feedings) may become necessary. Family members of those who have swallowing disorders should know how to perform the HEIMLICH MANEUVER to dislodge food that becomes aspirated into the TRACHEA.