Swallowing difficulty is common in every age especially in elderly. Solid and liquid foods get difficulty in reaching the stomach through the esophagus. It is rarely a sing for growing tumor or any other neurologic disease. If it does not resolve itself then you must admit to ear, nose, throat specialist.
How do you swallow?
We swallow hundreds of time during a day. There are four stages:
Oral preparation: Foods are chewed and prepared to be ready for swallowing.
Oral stage: Tongue pushes the solid and liquid food back of the mouth and swallowing starts.
Pharyngeal stage: Pharyx is the place between mouth and esophagus. Foods pass this part to reach esophagus.
Esophageal stage: Foods pass from here to stomach.
Human can control first and the second stages, but third and fourth stages are involuntary.
What causes swallowing disorders?
Any problem during swallowing can disturb it like bad teeth, bad teeth prosthesis, common cold etc. The most common reason is gastroesophageal reflux (contents of stomach coming back to esophagus). Other reasons: Nerve paralysis, progressive neurologic diseases, tracheostomy tube, vocal cord problems, tumors of the pharynx, esophagus, head and neck.
Signs of swallowing disorders can include the followings:
*Drooling of saliva
*Sensation like foods, liquids and saliva are staying in the esophagus.
*Dyscomfort in head and neck (especially in reflux)
*Foreign body sensation in the chest
*Weight loss and malnutrition because of long term swallowing problem.
*Reflux of food and liquids to the trachea because of difficult passage of them through the esophagus. It causes cough and choking sensation.
Who evaluates and treats the swallowing disorders?
Family practitioners can treat basic problems like “common cold, simple pharyngoesophageal reflux”. More complicated or unknown problems should be solved by the experts. These are ear, nose, throat specialists, gastroenterologists, radiologs, chest physicians, dieticians, neurology physicians, dentists, speech pathologists. A group study helps better.
Evaluation of a permanent swallowing disorder:
Ear, nose, throat physician takes a deep history and make a detailed examination in patients with permanent swallowing disorder. Can consultate with gastroenterologists if needed and can ask some radiologic examinations.
A neurologic consultation may be needed.
Probable treatments: They can be treated if the reason is found.
Many of these diseases can be treated with medicine. Drugs decreasing stomach acidity ad relaxing muscles. Treatment is according to the reason.
Gastroesophageal reflux can easily be treated by arranging eating and life habits:
*Eat frequently and semiliquid foods
*Stop alcohol and caffeine
*Decrease weight and stress
*Do not eat anything before going to bed.
*Elevate your head part in bed
If these do not help antiacid drugs can help.
Many swallowing disorders can be treated by direct swallowing method. Speech pathologist can teach how to activate your swallowing muscles and start nerve reflexes. To give a suitable position to their body easing the swallowing can be teached.
In some conditions operation is the choice. If there is a narrow place or synechia is formed they can be opened. “Myotomi” is another method to relax muscles. This operation is performed by ear, nose, throat head and neck surgeons.