Advance with MUSC Health

I feel like I can’t swallow or even chew. What’s happening?

Advance With MUSC Health
July 02, 2020
Ashley O'Rourke M.D.

Dysphagia is the medical term for difficulty swallowing. It is a common problem and can range in severity from a mild sensation of food sticking in your throat to a profound difficulty swallowing.

The problem can be located anywhere from the lips to the stomach and be connected with the muscles in the mouth or throat. If your oral structures are not strong enough to chew or guide food down the throat properly, or if you are getting food stuck in your airway and coughing while eating, you should consult a physician about dysphagia.

What Causes Dysphagia

There are many different causes of dysphagia, but the most common is neurologic, such as following a stroke or associated with Parkinson’s disease. Uncontrolled acid reflux can also cause swallowing issues, so preventative care is important if you experience acid reflux regularly.

When to Seek Medical Care

If food is continually getting trapped in the airway and causing violent coughing fits, you’re likely experiencing aspiration. While this happens occasionally for everyone, patients with dysphagia experience more concerning or abnormal symptoms such as chronic coughing, weight loss, and recurrent lung infections.

If you’re experiencing these symptoms you should be evaluated by an Ear, Nose, and Throat (ENT) doctor, also called an Otolaryngologist, or by a Speech Language Pathologist.

“Because dysphagia can start as a mild or intermittent issue, it can easily go undiagnosed in many patients,” shares Ashli K. O’Rourke, M.D. of the MUSC Health Health Ear, Nose, and Throat Department. “Mentioning coughing while eating, trouble swallowing or difficulty chewing during annual physicals is so important and can help patients get on the road to rehabilitation.”

How Dysphagia is Evaluated

The first step in evaluation is a clinical evaluation by a physician, or more commonly, a speech pathologist. After a thorough head, neck and cranial nerve examination, the practitioner watches a patient eat and drink different consistencies of food and liquid to observe for signs or symptoms of swallowing problems.

Following the clinical evaluation, more advanced testing includes:

  1. Flexible Endoscopic Evaluation of Swallowing (FEES) – This test involves placing a small endoscope through the nostril into the upper throat. While this is in place, the patient eats and drinks, and the clinician evaluates how the food is cleared from the throat or if it enters the airway.
  2. Modified Barium Swallow (MBS) – The patient will swallow different consistencies of food and liquid while a radiologist and speech pathologist evaluate the swallowing mechanism via x-ray. This evaluation is particularly useful as the clinicians can look at the different structures involved in swallowing, residue that might be left over after the swallow and the presence of aspiration or penetration into the voice box, windpipe or lungs.
  3. Esophagram – Similar to the MBS test, this test evaluates the function of the esophagus (food pipe) in much more detail using x-ray technology. The patient usually only swallows liquid or a Barium tablet, and the radiologist will evaluate for anatomic abnormalities, the squeezing power of the esophagus and the presence of gastric esophageal reflux.
  4. High Resolution Manometry (HRM) – This test is an advanced diagnostic technique that involves pressure testing of the throat and esophagus. After the nasal passages are numbed, a small catheter is placed through the nose, through the esophagus and into the stomach. The patient then swallows a salt water solution 10 to 20 times. This test is particularly helpful in measuring the strength of muscular contractions and the opening/closing of the upper and lower esophageal sphincters.

Treatment Options

Treatment primarily focuses on muscle strengthening exercises as well as strategies to compensate for the dysfunction. Patients will work with a Speech Language Pathologist for a treatment plan that will be continued at-home and in therapy sessions.

“Following through with treatment plans at home is crucial for rehabilitation,” shares Dr. O’Rourke, “Most dysphagia is treated with muscle strengthening exercises. There’s not a quick fix, and consistency is key.”

The FEES and HRM biofeedback tests prescribed above can be very helpful in addition to therapy. Biofeedback refers to the use of equipment to measure body functions that are not monitored consciously. These measurements can help clients learn to manipulate certain body functions using visual cues to develop more control.

There are some surgical options for treating anatomic problems causing dysphagia. For example, dilation of strictures or narrowing or removal of pouches or diverticula that may form.