- The first is oral
preparation, where food or
liquid is manipulated and chewed
in preparation for swallowing.
- During the oral stage,
the tongue propels the food or
liquid to the back of the mouth,
starting the swallowing
response.
- The pharyngeal stage
begins as food or liquid is
quickly passed through the
pharynx (the canal that connects
the mouth with the esophagus)
into the esophagus or swallowing
tube.
- In the final, esophageal
stage, the food or liquid
passes through the esophagus
into the stomach.
Although the first and second
stages have some voluntary control,
stages three and four occur by
themselves, without conscious input.
What causes swallowing disorders?
Any interruption in the swallowing
process can cause difficulties. It
may be due to simple causes such as
poor teeth, ill fitting dentures, or
a common cold. One of the most
common causes of dyphagia is
gastroesophageal reflux. This occurs
when stomach acid moves up the
esophagus to the pharynx, causing
discomfort. Other acuses may
include: stroke; progressive
neurological disorder; the presence
of a tracheostomy tube; a paralyzed
or unmoving vocal cord; a tumor in
the mouth, throat, or esophagus; or
surgery in the head, neck, or
esophageal areas.
Who evaluates and treats swallowing
disorders?
When dysphagia is persistent and the
cause is not aparent, the
otolaryngologist-head and neck
surgeon will discuss the history of
your problem and examine your mouth
and throat. This may be done with
the aid of mirrors or a small tube
(flexible laryngoscope), which
provides vision of the back of the
tongue, throat, and larynx (voice
box). If necessary, an examination
of the esophagus, stomach, and upper
small intestine (duodenum) may be
carried out by the otolaryngologist
or a gastroenterologist. These
specialists may recommend X-rays of
the swallowing mechanism, called a
barium swallow or upper G-I, which
is done by a radiologist.
If special problems exsist, a
speech pathologist ay consult with
the radiologist regarding a modified
barium swallow or videofluroscopy.
These help to identify all four
stages of the swallowing process.
Using different consistencies of
food and liquid, and having the
patient swallow in various
positions, a speech pathologist will
test the ability to swallow. An exam
by a neurologist may be necessary if
the swallowing disorder stems from a
nervous system, perhaps due to
stroke or other neurologic
disorders.
Symptoms
Symptoms of swallowing disorders may
include:
- drooling,
- a feeling that food or
liquid is stinking in the
throat,
- discomfort in the throat or
chest (when gastroesophageal
reflux is present),
- a sensation of a foreign
body or "lump" in the throat,
- weight loss and inadequate
nutrition due to prolonged or
more significant problems with
swallowing, and
- coughing or choking caused
by bits of food, liquid, or
saliva not passing easily during
swallowing, and being sucked
into the lungs.
Possible treatments
Many of these disorders can be
treated with medication. Drugs that
slow stomach acid production, muscle
relaxants, and antacids are a few of
the many medicines available.
Treatment is tailored tro the
particular cause of the swallowing
disorder.
Gastroesophageal reflux
can often be treated by changing
eating and living habits—for
example:
- Eat a bland diet with
smaller, more frequent meals,
- Eliminate alcohol and
caffeine,
- Reduce weight and stress,
- Avoid food within three
hours of bedtime, and
- Elevate the head of the bed
at night.
If these don't help, antacids
between meals and at bedtime may
provide relief.
Many swallowing disorders may be
helped by direct
swallowing
therapy. A speech
pathologist can provide special
excercises for coordinating the
swallowing muscles or restimulating
the nerves that trigger the swallow
reflex. Patients may also be taught
simple ways to place food in the
mouth or position the body and head
to help the swallow occur
successfully.
Some patients with swallowing
disorders have difficulty feeding
themselves. An occupational
therapist can aid the patient and
family in feeding techniques. These
techniques make the patient as
independent as possible. A dietician
or nutritional expert can determin
the amount of food or liquid
necessary to sustain an individual
and whether supplements are
necessary.
Surgery
is used to treat certain
problems. If a narrowing or
stricture exists, the area may need
to be stretched or dilated. If a
muscle is too tight, it may need to
be dilated or even released
surgically. This procedure is called
a myotomy and is performed by an
otolaryngologist-head and neck
surgeon.
Many causes contribute to
swallowing disorders. If you have a
persistent problem swallowing, see
ann otolaryngologist-head and neck
surgeon. |
