Swallowing is a reflex that generally develops before birth and continues doing so during infancy and childhood. Proper swallowing function involves the use of nerves and muscles in the mouth and throat. Swallowing dysfunction, also known as dysphagia, is very common amongst all ages. It is also one of the first motor skills to decline in seniors.
What Causes Difficulty Swallowing?
Swallowing is a four-step process that starts with chewing. Then the tongue propels the food towards the back of the mouth into the throat. Fluids and food travel down into the throat through the pharynx before entering the esophagus and ending up in the stomach for further digestion.
Difficulty swallowing can be either oropharyngeal or esophageal in nature. Oropharyngeal dysphagia occurs when the throat muscles are too weak to move food or liquids into the throat and esophagus or swallow. Oropharyngeal swallowing disorders are common among older individuals and those with certain underlying conditions. Esophageal dysphagia develops when the nerves at the base of the throat and chest send signals to the brain that food or an object is stuck, even when there is nothing there. This sensation is often more pronounced after meals, especially in patients with gastrointestinal health issues.
Symptoms of Dysphagia
GERD or acid reflux
Changes in appetite
Sensations of food in throat or chest, commonly after meals
Loss of swallowing ability
Certain lifestyle habits, such as excessive alcohol consumption, smoking, and trauma-causing accidents that injure the brain, mouth, or throat can affect one’s ability to swallow normally. Optimal tongue and throat health and function are essential in propelling food and liquid into the esophagus and stomach for proper digestion. Deficiencies increase the likelihood of swallowing difficulties, malnutrition, and life-threatening conditions.
Growing older alters the structure and function of the body. For example, poor oral health, such as missing or shifting teeth, poorly fitting dentures, and changes in the bone and muscle structure of the mouth can prevent proper chewing, thus increasing the risk of swallowing difficulties. Nerve dysfunction also plays a role in dysphagia development and progression. Diminished nerve sensitivity and responses make it harder to distinguish when food or fluid is in the mouth to swallow. A loss of muscle tone and strength is exceedingly common in older individuals who are also more vulnerable to developing dysphagia than their younger counterparts.
Aging also reduces the size of the esophagus, meaning the path for food and liquids to enter is narrower. The risk of esophageal sphincter dysfunction increases. In times of dysfunction, that valve may not release or relax enough to allow food and liquids to pass through safely. The throat also becomes more elongated. These changes can make swallowing incredibly difficult for the elderly, especially when consuming large portions of food or taking certain medications. The swallowing process takes longer to perform, increasing the risk of food or liquid entrapment and aspiration.
Infections and allergies
Some infections that target the airways can lead to swallowing issues. Colds, allergies, and other upper respiratory ailments cause swelling in the mouth or throat and can alter the structure and performance of the tongue and throat muscles responsible for swallowing. In the presence of severe infection or inflammation, consumed foods and liquids can enter the lungs, causing coughing and burning sensations in the throat and chest and even voice hoarseness. Frequent aspiration can lead to severe pulmonary and respiratory infections and other potentially life-threatening health conditions.
GERD and other health conditions
In some cases, dysphagia is a symptom of underlying medical issues. Swallowing challenges tend to persist until the causative condition is resolved. For example, gastroesophageal reflux disease (GERD) is a common digestive condition that affects approximately one out of five adults across the country. GERD causes stomach acid to reflux or travel upward into the esophagus and throat, often causing painful burning sensations. Untreated, acid reflux episodes can destroy the esophagus lining, causing the passage to become narrower, increasing the risk of dysphagia. Individuals with hypertension, thyroid disorders, paralyzed or damaged vocal cords, throat or mouth tumors, diabetes, osteoarthritis, neurological changes, and other progressive or chronic medical risk factors are more prone to pain and unpleasant sensations when swallowing than others.
Dysphagia is treatable with lifestyle changes and medical intervention. Some dysphagia patients find it easier to swallow after making lifestyle and dietary modifications, such as increasing their fluid intake, practicing proper breathing mechanics, eating smaller meal portions, taking more time to chew food, and improving their oral health.
Medication is effective for swallowing issues associated with GERD and other health conditions. Dysphagia stemming from unknown causes or motility problems is treatable with surgery. Laryngoscopy or upper endoscopy is advisable for tongue, throat, or larynx abnormalities.
Contact C/V ENT Surgical Group Today
To learn diagnostic and treatment options or discuss your swallowing concerns with our ear, nose, and throat surgeons, contact C/V ENT Surgical Group in Encino or West Hills and schedule a consultation.