Difficulty Swallowing

The medical term for difficulty swallowing is called dysphagia. The most common symptom of dysphagia is the inability to swallow solid food. This is usually described as food “becoming stuck” before it passes into the stomach or is regurgitated. Difficulty swallowing foods or liquids, arising from the throat or esophagus, ranging from mild to severe with even complete and painful blockage. Leaving your dysphagia untreated can cause additional health issues, such as dehydration, weight loss, choking, aspiration pneumonia and malnutrition.

Common Causes

Dysphagia can be caused by several different problems. One of the most common causes is from acid reflux. This is when stomach acid or bile flows back up into the esophagus and irritates the lining. Symptoms can include a burning sensation in the chest that usually occurs after eating and gets worse when lying down.

Neurologic disorders can cause dysphagia. Damage to the brain or nervous system from trauma, stroke, Parkinson’s disease, multiple sclerosis, dementia and motor neuron disease can leave the mouth, tongue, or throat muscles weak or with poor coordination. This can lead to coughing, choking, and even aspiration of food into the lungs leading to aspiration pneumonia.

Patients that have an esophageal ring (Shatzki’s ring) or a stricture as the cause of their dysphagia have problems associated with swallowing that usually result in an intense feeling of discomfort as a swallowed food slowly moves down the esophagus. Occasionally, they can result in food becoming stuck in the esophagus – which is known as food impaction.
You may have a bulge or a pouch called a Zenker’s diverticulum in the upper part of the esophagus. The diverticulum will trap food being swallowed, leading to choking, regurgitation of undigested food, and aspiration. The condition is more common among older adults.

Some pathologies will cause compression on the esophagus leading to troubles swallowing. Enlarged thyroid or a large thyroid nodule can press on the esophagus. Laryngeal cancer or esophagus cancer and causes narrowing or obstruction causing dysphagia.

Dysphagia can also have causes that are not due to underlying medical issues. Some examples are taking large bites of food, inadequate chewing, dry mouth, pill size, or food that’s too hot. Swallowing is also difficult when talking, laughing, or lying down.

Diagnosis and Treatment

When you have your consultation with your San Diego Ear, Nose & Throat Specialist, they will begin with a thorough review of your medical history. It is of great importance for your physician to understand what your swallowing-related symptoms are, their duration, association with foods and liquids, as well as the full range of treatments that you have tried, for how long you have tried them, and their efficacy. A thorough physical exam will be performed including a laryngoscopy, a small lighted/optical instrument will be used to look inside the throat. This will help evaluate both anatomical and functional abnormalities. Based on your medical history and physical exam, your ENT specialist may order additional tests, which could include a barium swallow x-ray, an upper endoscopy (EGD) or an esophageal muscle test (manometry).

Various therapies can reduce or eliminate the swallowing problem and restore a person’s ability to eat and enjoy normal foods. Treatment options include:

  • Speech therapy can help strengthen weak muscles or improve their coordination. This can be especially effective for the elderly.
  • If certain disorders have caused narrowing of the esophagus, an endoscope with a balloon attached may be used to gently expand the organ,
  • Surgical procedures may be performed to remove a tumor or a Zenker’s diverticulum
  • If dysphagia is caused by GERD, heartburn or inflammation, medicines and lifestyle changes may help prevent stomach acid from entering the esophagus.