Swallowing Problems

Treatment

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Oropharyngeal Dysphagia

Oropharyngeal dysphagia is likely to be treated by a team of specialists, including a neurologist, ENT doctor or speech pathologist. When this type of dysphagia results from neurological problems such as Alzheimer's or Parkinson's disease, stroke or spinal cord injury, the conditions must be treated. Swallowing therapy is performed to improve swallowing. Among conditions related to oropharyngeal dysphagia which Mayo phycicians treat are:

• Aspiration. In severe cases of mouth and throat swallowing disorders, food and liquids pass into the airway instead of the esophagus. This is called aspiration. People with aspiration sometimes choke and cough when they swallow and risk developing pneumonia or other lung problems. Sometimes aspiration occurs silently and is not discovered until respiratory problems develop.
• Malnutrition. People with severe mouth and throat swallowing disorders may lose weight and become weak. In these cases, a feeding tube is used to bypass the mouth and throat. A nasogastric (NG) tube is used for problems expected to last only a few weeks or months. For long-term problems, a percutaneous endoscopic gastrostomy (PEG) tube is placed directly through the skin into the stomach.
• Obstructions. Surgery is sometimes used to treat swallowing problems caused by obstructions, such as a pouch in the lower throat (Zenker's diverticulum), a narrowing of the lower throat (cricopharyngeus bar) or a bony outgrowth pushing against the throat (anterior cervical osteophytes).
• Vocal cord paralysis. Surgery may be indicated when swallowing problems are related to vocal cord paralysis. (See laryngeal suspension surgery.) Patients with this condition are seen by a throat surgeon and undergo a detailed throat examination.
• Oropharyngeal cancer. The goal is to eliminate the cancer and preserve as much function as possible.

Esophageal Dysphagia

Conditions leading to esophageal dysphagia are likely to be treated by a general practitioner or a gastroenterologist. Among these conditions are:

• Gastroesophageal Reflux Disease (GERD) can be treated with medications to reduce stomach acid.
• Esophageal strictures (narrowing of the esophagus) and Schatzki's ring (an abnormal ring of tissue located at the junction of the esophagus and the stomach) are treated with pneumatic dilation (an endoscope with a balloon at the end), medication and surgery in some cases.
• Eosinophilic esophagitis, often referred to as asthma of the esophagus, is treated by eliminating certain foods or with corticosteroid drugs.
• Motility disorders may be treated with medication or with pneumatic dilation to stretch the narrowed passage.
• Esophageal tumors/cancer treatments are tailored for the individual based on the extent of the cancer.

After surgery, patients usually undergo swallowing therapy under the guidance of a speech-language pathologist. They may recommend exercises, positions or strategies for more effective swallowing and specific food and liquid textures that are easier and safer to swallow. Patients may be asked to track how much food or liquid they consume.