Swallowing problems consist of any problem in which the normal movements associated with swallowing do not occur.
Normal swallowing of food and liquid requires coordination of a large number of muscles in the mouth, throat (pharynx) and esophagus (the tube that leads from the pharynx into the stomach).
As food is placed in the mouth, we close our lips to prevent drooling. Muscles of the tongue and jaw move around in the mouth for chewing. When chewing is finished, the food is collected into a ball by movements of the tongue.
The swallow begins as the tongue pushes the food upward and backward towards the back of the mouth and the throat. As the tongue pushes the food or liquid toward the back of the mouth, the muscles in the pharynx begin to move to receive the food. The top of the windpipe (larynx) begins to lift, move forward, and close to keep food from going into the lungs. The soft part of the roof of the mouth (the soft palate) lifts to close off the entrance to the nose.
As food passes over the back of the tongue and enters the pharynx, muscles in the pharynx contract to squeeze the food through the pharynx and into the esophagus. As the food approaches the entrance to the esophagus, the valve at the top of the esophagus opens to allow the food to pass. Muscles in the esophagus then contract to push the food from the top of the esophagus through the valve at the bottom of the esophagus and into the stomach.
Normal swallowing is a very fast process, taking less then 2 seconds to move the food from the mouth, through the pharynx, and into the esophagus. Normal swallowing is safe because the larynx is closed as the food passes. The food is normally moved efficiently through the mouth and pharynx, with very little trace of food or liquid left behind.
If a swallowing problem remains untreated the patient may become dehydrated because of the inability to swallow fluids. The patient also may lose weight and become malnourished because of difficulty in eating foods that require a lot of chewing, or foods of a particular thickness.
Pneumonia can result from a swallowing problem if food or liquid gets into the lungs while swallowing. The patient may have increased secretions as the lungs clean themselves of food or liquid.
In order to prevent these problems, patients with suspected swallowing problems should receive careful evaluation, followed by planned treatment.
Causes of a swallowing problem include damage to the nervous system such as a stroke.
Patients with diseases affecting muscle strength and coordination such as muscular dystrophy and cerebral palsy may have swallowing problems.
Patients who have progressive neurologic diseases such as Parkinson's disease, ALS, myasthenia gravis or Alzheimer's disease may also have problems.
Tumors of the head and neck and their treatment can also result in swallowing difficulties.
There are a large number of possible swallowing problems. There may be difficulties closing the lips, moving the tongue to control food during chewing or to push food from the front to the back of the mouth.
Muscles of the face may be weak and allow food to collect in the cheeks. There may be a problem with sensation in the mouth, so that the patient cannot feel where the food is located or even be aware that there is food in the mouth.
Some patients have difficulty in coordinating the muscles that close and protect the larynx or with muscles that close the valve into the nose. The control of muscles that push food through the pharynx may be damaged, causing food to be left behind in the throat. Or, the muscles of the esophagus may be damaged so that they cannot contract and put pressure on the food as it enters the esophagus.
Most common signs of a swallowing problem include:
- Coughing while eating or drinking or very soon after eating or drinking
- Wet sounding voice during or after eating
- Increased congestion in the chest after eating or drinking
- Slow eating
- Multiple swallows on a single mouthful of food
- Obvious extra effort or difficulty while chewing or swallowing
- Fatigue or shortness of breath while eating
- Temperature rising 30 minutes to an hour after eating
- Weight loss associated with increased slowness in eating
- Repetitive pneumonias
These signs should be brought to the attention of a physician.
No two patients are alike in their swallowing problem; careful evaluation is necessary.
There is a wide range of treatments, some which are as simple as changing the patient's head or body position when they swallow, or changing the kinds of foods they eat. Others involve the patient's learning new ways to swallow. Some procedures exercise muscles that are not working properly.