Swallowing is one of the most highly complex acts humans do on a daily basis. It is also a skill that is often taken for granted—that is, until a problem occurs. Swallowing problems are referred to as dysphagia. The different types of dysphagia are oropharyngeal, or problems that occur in the mouth or throat, and esophageal, problems that occur in the esophagus or food tube. The causes of dysphagia are many.
Stages of Swallowing
There are several stages involved in swallowing. The oral preparatory stage involves chewing food or holding liquid in preparation for swallowing. Any food not fully chewed or liquid that spills over the tongue prematurely may result in choking and or coughing. The oral stage involves moving the food or liquid by having the tongue push material from the front of the mouth to the back of the throat. Once the material reaches the throat, a reflexive pharyngeal swallow is triggered. The larynx or voice box rises, material courses around the airway and into the esophagus. Once material is in the esophagus, it is pushed through it into the stomach, the esophageal stage.
Causes of Swallowing Problems
Common causes for dysphagia include neurological diseases such as multiple sclerosis, Parkinson’s disease or Alzheimer’s disease, neurological damage from brain or spinal cord injury or strokes, some cancers, certain cancer treatments and age. The efficiency of swallowing decreases with age. Swallowing problems in children are not as common but do occur.
A few of the causes of childhood dysphagia include cerebral palsy--a neurological disorder--prematurity, or cleft palate. Swallowing requires well-timed, highly coordinated movements from one stage to the next. It takes about 50 pairs of muscles and nerves to swallow, according to MayoClinic.com. Any muscle weakness or damage to a nerve can disrupt the process.
Possible oral stage problems include difficulty chewing, difficulty controlling material in the mouth, moving it to the throat, or keeping it in the mouth due to inadequate lip closure. Problems in the pharyngeal stage may include aspiration, having material go into the trachea or windpipe, difficulty pushing the material into the esophagus and pharyngeal residue--leftover material in the throat following the swallow. Some esophageal problems involve material getting stuck in the esophagus or reflux, which occurs when material leaks back out of the esophagus following the swallow or after eating.
Dangers of Dysphagia
Dysphagia can be life-threatening. If material goes into the airway, it can become occluded or clogged, causing choking and eventual death. Aspiration pneumonia, brought about by material entering the lungs and subsequent infection, can create significant health issues. Dysphagia can compromise a person’s ability to take in adequate nutrition and hydration, resulting in malnutrition and dehydration.
Two of the tests for dysphagia are the barium X-ray study, during which a person swallows a contrast material called barium that is used to view all stages of the swallow, and endoscopy, which involves the placement of a flexible lighted tube through the nose to view oropharyngeal and/or esophageal stages of swallowing.
Treatment for Dysphagia
Treatment for dysphagia varies with the type of problem. Speech-language pathologists may provide specific exercises for muscle strengthening or strategies to help compensate for a specific deficiency in the swallow. Dysphagia diets vary the consistency and texture of foods and liquids for individuals with impaired swallowing. If a person is unable to swallow safely and or efficiently, non-oral means of feeding may be considered such as a feeding tube.