Swallowing problems (dysphagia)
Difficulty swallowing has no waiting period. Unlike hoarseness, where there is some time to wait, international guidelines treat swallowing difficulty as a reason for prompt investigation, even when it is mild. The feeling of a lump in the throat without any real difficulty swallowing is a different matter and is checked with a different approach.
What is dysphagia?
Dysphagia is the medical term for any difficulty moving food or liquid from the mouth to the stomach. It can show up as a feeling that food is getting stuck, a need to drink water to get it down, coughing or choking while eating, or meals that take much longer than they used to.
Swallowing and voice share the same mechanism.The voice box (larynx) closes the moment you swallow, so that nothing goes down the wrong way into the airway, and opens again so you can speak. That is why swallowing and hoarseness that won't go away often appear together and are checked with the same examination.
Swallowing difficulty or a lump in the throat?
This is the most common confusion, and the distinction changes the whole picture.
- Swallowing difficulty (dysphagia) means food really has trouble getting through. It needs to be investigated without waiting
- A feeling of a lump in the throat means you feel something in your throat, but you eat and drink normally. It is usually caused by silent reflux (laryngopharyngeal reflux) or muscle tension, and in most cases it is benign
The difference is not judged by how much it bothers you, but by whether the food gets through. In both cases, it can only be confirmed after the throat and voice box have been examined, because in rare cases the same sensation can hide something else.
What can cause it?
- Silent reflux (laryngopharyngeal reflux), which causes swelling and irritation in the throat and voice box
- Neurological causes, such as after a stroke or in Parkinson's disease, where the coordination of swallowing is disrupted
- Age-related changes, with gradual weakening of the swallowing muscles
- After radiotherapy or surgery in the neck area
- Zenker's diverticulum, a pouch in the throat that traps food
- A narrowing or a mass in the throat, voice box or esophagus, which is exactly why we do not let swallowing difficulty wait
When should you get it checked?
Right away. International guidelines classify swallowing difficulty on its own, without any other symptom, as a reason for prompt investigation. There is no waiting period as there is with hoarseness.
It becomes even more urgent if any of the following is also present:
- The difficulty is gradually getting worse, or it started with solid food and now affects liquids too
- Unexplained weight loss
- Pain when swallowing
- Coughing or choking while eating, or repeated chest infections
- Hoarseness that appeared together with the swallowing difficulty
- A lump you can feel in your neck
What happens at the appointment?
After talking through your history, focusing on when it started, which food textures are difficult and whether you have lost weight, there is a physical examination of the mouth, the neck and the cranial nerves involved in swallowing.
Throat and voice box endoscopy
This is done with a thin, flexible endoscope through the nose, at the practice. It shows the base of the tongue, the throat and the voice box, which is exactly the area where the critical part of swallowing happens.
Endoscopic swallowing assessment
This is the difference from a standard examination. With the endoscope in place, you are asked to swallow foods of different textures, so that swallowing itself can be seen in action: whether food remains in the throat, whether the voice box closes in time and whether food goes down the wrong way into the airway. The rehabilitation plan is based on these findings.
ENT or gastroenterologist?
Many patients with swallowing difficulty start with the wrong specialist and lose time. The rule that helps is where you feel it gets stuck.
- High up, in the throat, with coughing or choking while eating: start with an ENT, because the problem is in the throat and voice box.
- Low down, behind the breastbone, with a feeling that the food has stopped: start with a gastroenterologist, because the problem is more likely in the esophagus.
The distinction is not absolute, and the 2 specialties often work together. It does help ensure the right examination is done first, instead of repeating 2.
Treatment
Non-surgical treatment
- Swallowing rehabilitation with a speech therapist, with exercises and techniques based on the findings of the examination
- Adjusting the texture of food and liquids while rehabilitation is ongoing
- Treatment of silent reflux, where this is the cause
- Guidance on posture and pace while eating, which reduces the risk of food going into the airway
When surgery is needed
Surgery is for causes with a structural explanation, such as Zenker's diverticulum, a narrowing or a mass. In these cases, treatment is planned after a full investigation and, where needed, together with other specialties.
Frequently asked questions
Urgent enough that it should not wait. International guidelines classify swallowing difficulty on its own as a reason for prompt investigation, regardless of how severe it is.
No. A feeling of a lump without any real difficulty swallowing is usually benign, but this can only be confirmed after the throat and voice box have been examined.
No. It is done with a thin, flexible endoscope through the nose while you swallow, and takes a few minutes.
Coughing while eating means that food or liquid is going toward the voice box instead of the esophagus, and it is one of the findings that needs prompt assessment.
Often yes, temporarily, by adjusting the texture of food until the cause is treated.
A speech therapist who specializes in swallowing problems, based on the findings of the endoscopic examination.
Don't let it wait
Difficulty swallowing
No waiting period
Even if mild, even without pain, swallowing difficulty is investigated from the start.
Coughing or choking while eating
Right away
It means food or liquid is going into the airway.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Suspected cancer: recognition and referral (NG12), NICE, ενότητα για τον οισοφάγο.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
