Swallowing Difficulty Treatment (Dysphagia)
Difficulty swallowing, known medically as dysphagia, is the sensation that food or drink is slow to go down, sticks in the throat or chest, or is uncomfortable to swallow.
It can range from a mild, occasional nuisance to a problem that interferes with eating, drinking and nutrition. Swallowing difficulty should always be assessed, both to relieve the symptom and to make sure that nothing serious is being missed.
As a laryngologist, I specialise in conditions of the throat and voice box, and I am well placed to assess swallowing problems that arise in the upper throat and at the entrance to the gullet.
When a cough lasts longer than eight weeks and the usual causes have been investigated and treated, it is described as a chronic cough.
In many people the underlying problem is that the nerves supplying the throat and voice box have become oversensitive, so that minor triggers such as talking, laughing, a change in air temperature or a tickle in the throat set off coughing or repeated throat clearing. This is sometimes called chronic cough hypersensitivity or neurogenic cough.
As a laryngologist, I have a particular interest in coughs and throat-clearing that have not responded to standard treatments, and I offer specialised options that are not widely available.
Symptoms of swallowing difficulty
- A feeling that food or tablets stick in the throat or chest
- Needing to swallow several times or wash food down with fluids
- Coughing or choking while eating or drinking
- Bringing food back up (regurgitation)
- A sensation of a lump in the throat
- Unintended weight loss or recurrent chest infections in more significant cases
What causes swallowing problems?
There are many possible causes, including:
- Inflammation of the throat or gullet
- A tight ring of muscle at the top of the gullet (cricopharyngeal muscle), which can also cause a pouch to form
- Weakness or incoordination of the swallowing muscles, sometimes related to neurological conditions
- Problems with the voice box, including vocal cord paralysis
- Narrowing of the gullet, or, less commonly, growths that need to be excluded
- Connective tissue conditions affecting the throat, such as Ehlers-Danlos syndrome
How I assess swallowing difficulty
I begin with a detailed history of your symptoms, followed by an examination of the throat and voice box using a thin flexible camera passed gently through the nose (nasendoscopy). Where helpful, I can carry out or arrange a more detailed assessment of the swallow itself, such as a fibre-optic endoscopic evaluation of swallowing (FEES) or a contrast X-ray (videofluoroscopy or barium swallow), and I work closely with speech and language therapists and gastroenterology colleagues. The priority is to identify the cause precisely so that treatment can be targeted.
What causes swallowing problems?
There are many possible causes, including:
- Inflammation of the throat or gullet
- A tight ring of muscle at the top of the gullet (cricopharyngeal muscle), which can also cause a pouch to form
- Weakness or incoordination of the swallowing muscles, sometimes related to neurological conditions
- Problems with the voice box, including vocal cord paralysis
- Narrowing of the gullet, or, less commonly, growths that need to be excluded
- Connective tissue conditions affecting the throat, such as Ehlers-Danlos syndrome
Treatment Options
Treatment depends entirely on the underlying cause and may include:
- Managing reflux and inflammation with lifestyle measures and medication
- Swallowing therapy with a speech and language therapist to strengthen and coordinate the swallow
- Treating a tight cricopharyngeus muscle by stretching (dilatation), Botox injection or a small endoscopic procedure
- Addressing voice-box problems that affect swallowing, such as repositioning a paralysed vocal cord
- Onward referral where the cause lies lower in the gullet or requires a different specialist
I will explain what is causing your swallowing difficulty and recommend the treatment most likely to help, coordinating your care with other specialists where needed.
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FAQs
When should I worry about difficulty swallowing?
Any persistent difficulty swallowing should be assessed. You should seek prompt advice if swallowing problems are worsening, if food is genuinely sticking, or if they are accompanied by weight loss, coughing up blood, a persistent hoarse voice or repeated chest infections. Early assessment allows the cause to be identified and treated, and reassures you when nothing serious is found.
What tests are used to investigate swallowing problems?
Assessment usually starts with a camera examination of the throat and voice box (nasendoscopy). Depending on the findings, this may be followed by a fibre-optic evaluation of swallowing (FEES), a contrast X-ray such as a barium swallow or videofluoroscopy, or onward investigation of the gullet. I will arrange the tests most relevant to your symptoms.
Can swallowing difficulty be cured?
Many causes of swallowing difficulty respond very well to treatment, whether that is swallowing therapy, stretching a tight muscle or addressing a voice-box problem. The outlook depends on the underlying cause, which is why an accurate diagnosis is so important.
Is swallowing difficulty related to my voice or throat sensitivity?
It can be. Problems with the voice box, throat-nerve sensitivity and the muscles at the top of the gullet are closely linked, which is why a laryngologist who specialises in the throat and voice box is well placed to assess swallowing difficulties that arise in this area.