Swallowing Difficulties

Difficulty in swallowing is also called dysphagia. This is a serious problem which can lead to aspiration pneumonia, malnutrition, dehydration and weight loss.

(Aspiration Pneumonia: When one inhales food etc. into the lungs. While healthy lungs are able to clear the debris out, weak lungs may not be able to and pneumonia can develop.)

Patients with dysphagia (swallowing problems) typically complain of choking or coughing when they eat. They may find it difficult to initiate swallowing or find that certain types of food get stuck in their throats.

Some patients may have a change in voice (wet or breathy voice). If the problem becomes severe, they may develop pneumonia or may be afraid of eating.

1. Central Nervous System Disorders
   1. As we age, the prevalence of dysphagia increases
   2. Conditions like strokes, dementia, Parkinson's disease are commonly associated with dysphagia in the elderly
2. Muscular Disorders
   1. Muscular disorders may be genetic (e.g. muscular dystrophy) or inflammatory (e.g. polymyositis) in origin, and can prevent one from having full control over swallowing
3. Neuropathic Causes
   1. Damage to the nerves in the larynx (voice box) may affect the ability of the larynx to protect the windpipe from aspiration (inhaling foreign objects, like food, into the lungs)
4. Drug Induced
   1. Medications that can affect swallowing include anti-psychotics, lipid lowering medication, long term steroid use, and medications that cause drowsiness
5. Endocrine Disorders
   1. Hypo or hyperthyroidism, Cushing syndrome may be associated with dysphagia
6. Cancer
   1. Cancer of the throat or oesophagus can lead to dysphagia
   2. More prevalent in smokers and those who consume alcohol regularly

Your ENT specialist may order some investigations to look for the cause and evaluate the severity of the dysphagia.

The most important decision your doctor has to make is whether it is safe for you to continue eating orally. This has important consequences on your nutrition, quality of life and the likelihood of developing aspiration pneumonia.

Physical Examinations:

1. Modified Barium Swallow (MBS) & Fibre-Optic Endoscopic Evaluation (FEES)
   1. Allows the doctor to see what happens during swallowing
   2. Allows for greater accuracy in choosing the most appropriate therapy or surgery
2. CT / MRI / Blood Tests
   1. May be given if the doctor wants to exclude certain causes of dysphagia

Management of dysphagia may include:

1. Swallow Exercises and Facilitation Techniques
   1. These exercises help to strengthen the swallowing muscles
2. Compensatory Techniques
   1. These techniques reduce the risk of aspiration, thus making it safer for the at-risk patient
   2. E.g. chin-tuck position, head-turn to the affected side and the supraglottic swallow
3. Diet Modification
   1. In general, the risk of aspiration is highest with thin liquids
   2. Modification of food texture and consistency helps to reduce the risk of aspiration while maintaining adequate hydration and caloric intake
4. Enteral Feeding
   1. This may be achieved through nasogastric tube feeding or via a percutaneous endoscopic gastrostomy tube
   2. This form of feeding will be necessary if the risk of aspiration is high
5. Surgery for Chronic Aspiration
   1. Surgery may help improve swallowing in selected cases