Swallowing Disorders

Multidisciplinary Management of Swallowing Disorders

Everyone has trouble swallowing from time to time, such as choking while eating or drinking. People with swallowing disorders (dysphagia) regularly have difficulty swallowing, which can lead to choking, malnutrition, and other problems.

Swallowing is a complex process, with many nerves working to coordinate the muscles of the mouth, throat, and esophagus. A wide range of conditions, illnesses, and their treatments can disrupt this process, causing difficulty swallowing.

Serving the Dallas/Fort Worth area and beyond, our fellowship-trained laryngologists (ear, nose, and throat doctors with specialized training in disorders of the larynx) and speech-language pathologists have advanced training and years of expertise in care for swallowing disorders. We quickly determine the cause of the difficulty, and we often work with gastroenterologists (specialists in digestive disorders) to coordinate care for our patients.

Causes of Swallowing Disorders

Dysphagia can result from a wide variety of problems, which typically affect the esophagus differently from the mouth and throat. The categories of swallowing disorders and their causes include:

Mouth and throat dysphagia

• Head and neck cancer and certain cancer treatments, such as radiation therapy
• Neurological damage to the brain or spinal cord caused by a stroke, a brain or spinal cord injury, or myasthenia gravis
• Neurological disorders such as multiple sclerosis, or Parkinson's disease
• Zenker’s diverticulum, a pouch that forms in the lower throat and can trap food
• Upper esophageal sphincter dysfunction (cricopharyngeal bar/spasm)

Esophageal dysphagia

• Achalasia, when the lower esophageal sphincter (ring of muscle) doesn’t open properly to pass food to the stomach
• Diffuse spasm, which is abnormal spasms of the esophagus muscles
• Esophageal cancer and radiation therapy to treat it
• Esophageal ring, an abnormal ring of tissue that forms in the lower esophagus
• Esophageal structure (narrowing), usually resulting from scar tissue caused by radiation, chemicals, medicines, chronic swelling, ulcers, or infection
• Esophageal tumors, either cancerous or noncancerous
• Gastroesophageal reflux disease (GERD)
• Something stuck in the esophagus, such as a piece of food
• Scleroderma, a disorder in which the immune system mistakenly attacks tissue in the esophagus

Symptoms of Swallowing Disorders

Signs and symptoms of dysphagia can include:

• Cough or gag reflex when swallowing
• Food or stomach acid that backs up into the throat
• Frequent heartburn
• Hoarseness
• Inability to swallow
• Pain while swallowing
• Regurgitation (food that comes back up)
• Sensation of food stuck in the throat or chest
• Unexplained weight loss

Diagnosis of Swallowing Disorders

At UT Southwestern, our laryngologists begin with a thorough evaluation, which includes a:

• Physical exam
• Review of personal medical history
• Discussion of symptoms

Depending on each patient’s particular situation, we’ll work with our UT Southwestern colleagues who are specialists in other areas of medicine.

To further evaluate swallowing function, our speech-language pathologists usually perform one or more tests, such as a:

• Clinical swallow evaluation: Test to assess how well the patient can swallow various foods and liquids
• Fiber-optic endoscopic evaluation of swallowing (FEES): Minimally invasive procedure that involves passing an endoscope (narrow, flexible tube) through the mouth to evaluate movement inside the throat while swallowing
• Videofluoroscopic swallowing evaluation: Imaging that analyzes swallowing on video X-rays taken while the patient swallows food and/or drink containing barium, which shows up in the X-ray

Treatment for Swallowing Disorders

Once we complete the evaluation, our team works with each patient to develop an individualized treatment plan that addresses each patient’s specific needs. For most patients, we begin with nonsurgical treatment options such as:

• Changes in eating habits, such as cutting food into small pieces, chewing thoroughly, and eating slowly
• Exercises that help coordinate the muscles involved in swallowing
• Swallowing techniques, including head and body positioning, to improve swallowing and prevent choking
• VitalStim^® therapy, a noninvasive, painless treatment using electrical stimulation to strengthen the muscles used in swallowing

 For patients who need additional treatment, we partner with other specialists to coordinate care that might include:

• A feeding tube to bypass the area that isn’t working properly and provide adequate nutrition
• In-office procedures, such as vocal cord injections
• A liquid diet to provide adequate nutrition
• Medications to treat conditions such as GERD
• Minimally invasive endoscopic procedures, such as esophageal dilation and trans-nasal esophagoscopy (TNE), to treat a wide range of esophageal conditions
• Surgery to treat blockages, narrowed areas, or cancer in the esophagus