January/February 2005
Page 13
That's Hard To Swallow
Sometimes we hear something we don't believe, and we call it "hard to swallow." There are also those of us who experience this in a literal way in other words, we actually have a hard time with the act of swallowing. What does it mean? Dysphagia, as it is called, refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. It may be caused by a number of factors, most of which are temporary in nature. About 15 million Americans find swallowing difficult, and older people are often the ones having these bouts of discomfort. Even the simple act of downing a cold drink can cause severe coughing and choking, and, in some cases, this can be a
life-threatening event. If you have trouble swallowing, see an otalaryngologist. When a swallowing problem fails to improve after a few weeks, it's especially important to seek medical attention because this is sometimes indicative of a serious disease, such as a tumor or a progressive neurological disorder. Swallowing involves four stages: oral preparation (food is chewed, liquids are manipulated); oral stage (tongue propels food or liquid to the back of the mouth, which starts the swallowing process); pharyngeal stage (quick passage of food and liquid through the pharynx into the esophagus); esophageal. stage (food and liquid pass through the esophagus into the stomach). The first and second have some voluntary control, but stages three and four occur naturally. So, how can you have problems with a process that seems so simple? Something interrupts the cycle, and this interruption can be caused by easily resolvable problems such as poor teeth, ill-fitting dentures, or a cold. But, one of the most common causes is gastro esophageal reflux, which occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Common symptoms are heartburn, indigestion, and sore throat, often aggravated by lying down, especially following eating. Treating reflux involves changing dietary habits. You may be asked to eat low-fat food and small meals; also, you should avoid bedtime snacks, caffeine, alcohol, tobacco, and spicy foods. You can prevent high acidity with prescription or over-the-counter medicines or antacids. Some people have trouble swallowing because tension or stress has triggered throat muscle spasms, which have resulted in a "lump" sensation. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation. Other causes of swallowing troubles are stroke, progressive neurological disorders, presence of a tracheotomy tube, a paralyzed or unmoving vocal cord, a tumor in the mouth, throat, or esophagus, or previous surgery in the head, neck or esophageal areas. Symptoms of swallowing difficulty can include a feeling that your food or drink is sticking in your throat; discomfort in the throat or chest; a "lump" in the throat; weight loss; coughing or choking caused by food, liquid, or salvia being aspirated into the windpipe and lungs. The time to worry is when food really doesn't go down normally. Coughing and chronically experiencing "food going down the wrong pipe" are good reasons to seek medical attention. Examining the mouth and throat can be done with mirrors or a small tube (flexible laryngoscope), which allows an otolaryngologist to see the back of the tongue, throat, and voice box. If necessary, your doctor may examine the esophagus, stomach, and upper small intestine and may order special X rays. If you're a heavy smoker or drinker, a tumor or cancer might be the cause of a swallowing problem, and immediate medical attention is required, with a thorough head and neck evaluation. Remember this rule of thumb: if it feels like something is stuck 'in your throat, and the feeling lasts for several weeks, you should see a doctor. In most cases, a swallowing problem is not serious, and it's usually easily resolved.
SOURCE:From the Shoulders Up, Fall 1998, Midwest Otolaryngology, Via: Ostomy Mail, Evansville, IN January 2005, via Inside Out On-line Jan/Feb 2005
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