Difficulty swallowing (medically termed dysphagia), can occur in both children and adults. Diana N. Kirke, MD, MPhil, Assistant Professor of Otolaryngology – Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai and a laryngologist/head and neck surgeon at The Grabscheid Voice and Swallowing Center, explains the condition and answers some of the most frequently asked questions.
What are the symptoms of dysphagia and what causes the condition?
People suffering from dysphagia may experience symptoms such as gagging or choking, excessive throat clearing, food or liquid “going down the wrong way,” increased eating time, unexplained weight loss, coughing during or after eating/drinking, and/or painful swallowing.
Various medical issues can lead to this condition. However, dysphagia is more common in the elderly and in those with neurological conditions such as stroke, brain injury, and dementia.
When should I see a health care provider about difficulty swallowing?
Acute dysphagia, in which symptoms persist for 24 hours, requires immediate evaluation in the emergency room, as it may be related to food impaction or an ingested foreign body. Symptoms of difficulty swallowing that are present for more than 10 days should be assessed in an outpatient office setting.
What can I expect during my office visit?
Your physician will perform a complete head and neck examination to assess your upper aerodigestive system, which includes the mouth, throat, and windpipe. A fiber-optic nasal endoscopy may also be conducted. Using a topical anesthetic, a fiber-optic endoscope will be passed through your nostril to examine the nasal cavity and throat. This procedure generally does not last longer than one minute. An assessment by a speech therapist will also be undertaken either at the same visit or at a later visit. The speech therapist will assist in gathering diagnostic information regarding the swallow and may provide swallow therapy techniques in order to overcome swallowing difficulty.
Will I need further evaluations?
Depending on your initial assessment, the physician and the speech therapist may perform the following in-office or out-of-office swallow evaluations:
- Using local anesthetic, a transnasal esophagoscopy may be performed to view the esophagus. During the procedure, a small camera is passed through the nostril.
- To view the throat before and after drinking, a static endoscopic evaluation of swallow (SEES) may be performed. During this procedure, a rigid camera is passed into the mouth for observation. SEES can also be used to assess vocal cord vibration.
- Speaking and swallowing tasks may be examined during a flexible endoscopic examination of swallow which is performed using a fiber-optic endoscope.
- To assess the functionality of all phases of swallowing, a modified barium swallow may be performed. During this fluoroscopic X-ray exam, you will ingest barium-containing liquids and coated food. The procedure will also assess whether any food or liquid is entering into the lungs.
What is swallowing therapy?
Following a complete assessment by your treating physician and speech therapist, you may be prescribed swallowing therapy. This may entail dietary modifications and/or exercises that aim to coordinate and strengthen the swallowing muscles. Generally a treatment plan is prescribed and you will be reassessed again at a later date.
Will I need surgery?
It depends. Some cases of swallowing dysfunction, such as Zenker’s diverticulum, may be amenable to an in-office or surgical procedure. In other cases, an aesthetic neurotoxin like Botox® can be injected in the office to weaken the swallowing muscles and allow food to pass more easily. Botox is used to treat dysphagia-causing conditions such as cricopharyngeal spasm—in which throat muscles spasm uncontrollably— or esophageal web—in which thin membranes occur along the esophagus.
Should I wait to see if my swallowing problem resolves?
No. All dysphagia complaints should be assessed and you should see a doctor immediately if your symptoms are affecting your ability to consume food and drink. If you are able to eat and drink normally, you can observe your symptoms at home for up to 10 days before seeing a physician.
Diana N. Kirke, MD, MPhil
is an otolaryngologist-head and neck surgeon at Mount Sinai Doctors, 5 East 98th Street, and laryngologist at The Grabscheid Voice and Swallowing Center of Mount Sinai. Dr. Kirke cares for patients with voice, airway and swallowing disorders, head and neck cancers and general ear, nose and throat diseases.
