Dysphagia
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People with dysphagia have difficulty swallowing and may also experience
pain while swallowing. Some people may be completely unable to swallow or
may have trouble swallowing liquids, foods, or saliva. Eating then becomes
a challenge. Often, dysphagia makes it difficult to take in enough calories
and fluids to nourish the body.
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Swallowing is a complex process. Some 50 pairs of muscles and many
nerves work to move food from the mouth to the stomach. This happens in
three stages. First, the tongue moves the food around in the mouth for
chewing. Chewing makes the food the right size to swallow and helps mix
the food with saliva. Saliva softens and moistens the food to make
swallowing easier. During this first stage, the tongue collects the
prepared food or liquid, making it ready for swallowing.
The second stage begins when the tongue pushes the food or liquid to
the back of the mouth, which triggers a swallowing reflex that passes the
food through the pharynx (the canal that connects the mouth with the
esophagus). During this stage, the larynx (voice box) closes tightly and
breathing stops to prevent food or liquid from entering the lungs.
The third stage begins when food or liquid enters the esophagus, the
canal that carries food and liquid to the stomach. This passage through
the esophagus usually occurs in about 3 seconds, depending on the texture
or consistency of the food.
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Dysphagia occurs when there is a problem with any part of the
swallowing process. Weak tongue or cheek muscles may make it hard to move
food around in the mouth for chewing. Food pieces that are too large for
swallowing may enter the throat and block the passage of air.
Other problems include not being able to start the swallowing reflex (a
stimulus that allows food and liquids to move safely through the pharynx)
because of a stroke or other nervous system disorder. People with these
kinds of problems are unable to begin the muscle movements that allow food
to move from the mouth to the stomach. Another difficulty can occur when
weak throat muscles cannot move all of the food toward the stomach. Bits
of food can fall or be pulled into the windpipe (trachea), which may
result in lung infection.
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Dysphagia can be serious. Someone who cannot swallow well may not be
able to eat enough of the right foods to stay healthy or maintain an ideal
weight.
Sometimes, when foods or liquids enter the windpipe of a person who has
dysphagia, coughing or throat clearing cannot remove it. Food or liquid
that stays in the windpipe may enter the lungs and create a chance for
harmful bacteria to grow. A serious infection (aspiration pneumonia) can
result.
Swallowing disorders may also include the development of a pocket
outside the esophagus caused by weakness in the esophageal wall. This
abnormal pocket traps some food being swallowed. While lying down or
sleeping, a person with this problem may draw undigested food into the
pharynx. The esophagus may be too narrow, causing food to stick. This food
may prevent other food or even liquids from entering the stomach.
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Dysphagia has many causes. Any condition that weakens or damages the
muscles and nerves used for swallowing may cause dysphagia. For example,
people with diseases of the nervous system, such as cerebral palsy or
Parkinson's disease, often have problems swallowing. Additionally, stroke
or head injury may affect the coordination of the swallowing muscles or
limit sensation in the mouth and throat. An infection or irritation can
cause narrowing of the esophagus. People born with abnormalities of the
swallowing mechanism may not be able to swallow normally. Infants who are
born with a hole in the roof of the mouth (cleft palate) are unable to
suck properly, which complicates nursing and drinking from a regular baby
bottle.
In addition, cancer of the head, neck, or esophagus may cause
swallowing problems. Sometimes the treatment for these types of cancers
can cause dysphagia. Injuries of the head, neck, and chest may also create
swallowing problems.
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There are different treatments for various types of dysphagia. First, doctors
and speech-language pathologists who test for and treat swallowing disorders
use a variety of tests that allow them to look at the parts of the swallowing
mechanism. One test, called a fiber optic laryngoscopy, allows the doctor
to look down the throat with a lighted tube. Other tests, including video
fluoroscopy, which takes videotapes of a patient swallowing, and ultrasound,
which produces images of internal body organs, can painlessly take pictures
of various stages of swallowing.
Once the cause of the dysphagia is found, surgery or medication may
help. If treating the cause of the dysphagia does not help, the doctor may
have the patient see a speech-language pathologist who is trained in
testing and treating swallowing disorders. The speech-language pathologist
will test the person's ability to eat and drink and may teach the person
new ways to swallow.
Treatment may involve muscle exercises to strengthen weak facial
muscles or to improve coordination. For others, treatment may involve
learning to eat in a special way. For example, some people may have to eat
with their head turned to one side or looking straight ahead. Preparing
food in a certain way or avoiding certain foods may help other people. For
instance, those who cannot swallow liquids may need to add special
thickeners to their drinks. Other people may have to avoid hot or cold
foods or drinks.
For some, however, consuming foods and liquids by mouth may no longer
be possible. These individuals must use other methods to nourish their
bodies. Usually this involves a feeding system, such as a feeding tube,
that bypasses the part of the swallowing mechanism that is not working
normally.
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Scientists are conducting research that will improve the ability of
physicians and speech-language pathologists to evaluate and treat
swallowing disorders. All aspects of the swallowing process are being
studied in people of all ages, including those who do and do not have
dysphagia. For example, scientists have found that there is great
variation in tongue movement during swallowing. Knowing which tongue
movements cause problems will help physicians and speech-language
pathologists evaluate swallowing.
Research has also led to new, safe ways to study tongue and throat
movements during the swallowing process. These methods will help physician
and speech pathologists safely reevaluate a patient's progress during
treatment. Studies of treatment methods are helping scientists discover
why some forms of treatment work with some people and not with others. For
example, research has shown that, in most cases, a patient who has had a
stroke should not drink with his or her head tipped back. Other research
has shown that some patients with cancer who have had part or all of their
tongue removed should drink with their head tipped back. This
knowledge will help some patients avoid serious lung infections and help
others avoid tube feedings.
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If you have a swallowing problem, you may need to consult with an
otolaryngologist (physician with special training in disorders of the ear,
nose, and throat) or a speech-language pathologist trained in dysphagia.
You may need to consult with a neurologist if a stroke or other neurologic
disorder causes the swallowing problem. Other trained professionals who
may provide treatment are occupational therapists and physical
therapists.
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American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
American Speech-Language-Hearing
Association (ASHA)
National Cancer Institute
(NCI)
National Institute of
Dental and Craniofacial Research (NIDCR)
National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK)
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