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 this occurs, 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 two 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, numerous problems can result. Dehydration may result when the patient is unable to swallow fluids. The patient also may lose weight and become malnourished because of difficulty in eating thick foods or foods that require a lot of chewing. Difficulty swallowing may also cause food to pass through the vocal cords and into the lungs. The patient may have increased secretions as the lungs try to clean themselves of this food. Infection may also set in and result in pneumonia.
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 neurological diseases such as Parkinson's disease, ALS (Lou Gehrig’s disease), 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. The upper esophageal sphincter fails to relax. Sometimes a pouch develops at the junction of the throat and esophagus (Zenkers diverticulum). Tumors of the larynx, pharynx or esophagus can also interfere with swallowing, as well as strictures (narrowing) of the esophagus.
Most common symptoms 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
Feeling like food is sticking on the way down
Regurgitation of food more than 30 minutes after eating
Fatigue or shortness of breath while eating
Temperature rising 30 minutes to an hour after eating
Weight loss associated with increased slowness in eating
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.
