Swallowing disorders

Swallowing Disorders: Ingestion is the process of transporting food from the mouth to the stomach, through the pharynx and esophagus.

The swallowing process includes 3 phases:

  1. Oral phase. Food is shredded and mixed with saliva to form bolus. At the same time, the elements of the food are sorted, in order to eliminate its potentially harmful elements, such as foreign bodies (e.g. fish bone). The bolus is then propelled towards the pharynx.
  2. Pharyngeal phase. The tongue and soft palate are elevated and the epiglottis is collapsed so that the bolus passes rapidly from the pharynx to the esophagus without entering the respiratory tract.
  3. Esophageal phase. The esophagus, with peristaltic movements, promotes the bolus towards the stomach.
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Fig.1: Pharyngeal phase of swallowing

Any anatomical or functional disorder can lead to swallowing disorders, which can set in acutely or gradually.

The presence of food residues in the mouth, the presence of pain when swallowing (odynophagia), the difficulty in swallowing (dysphagia), the reflux of food, with its exit from the nose (anorrhoea), the presence of cough and burning, retrosternal pain when taking food (laryngopharyngeal reflux) and the entry of food into the larynx (absorption), with a cough, a feeling of suffocation or pneumonia, are symptoms of a disorder of the swallowing mechanism.

What is the diagnostic approach to swallowing disorders?

  • Record: Looking for the symptoms that bother the patient, when they appear in relation to food intake and if they differ according to the composition of the food (solid, liquid, liquid). Possible side effects – complications such as signs of dehydration and weight loss are being looked for. Finally, it is clarified whether the onset of symptoms is temporally related to a surgery or to the initiation of a medication. Possible coexisting diseases are reported to the attending physician.
  • Clinical examination: A complete otorhinolaryngological examination, with an accompanying control of the function of the nerves involved in the swallowing mechanism, must be carried out. Cornerstone in the diagnosis, is the endoscopic control of the upper aerodigestive tract, with a rigid or flexible endoscope, where its anatomical and functional integrity, the presence of pathological swellings, the mobility of the vocal cords, food posture and saliva retention are checked.
    • The examination is completed, whenever deemed necessary, by conducting FEES (Fiberoptic Endoscopic Evaluation of Swallowing). During this test, food is successively given to the patient, of different consistency and quantity, while at the same time, with the flexible nasopharyngolaryngoscope, we check the mechanism of swallowing. In this way, we check in real time if the food stagnates somewhere, if it returns or if it enters the respiratory tract. The test is performed under local anesthesia, is painless and well tolerated by the patient.
Fig.2: Endoscopic examination with a flexible endoscope
  • Paraclinical control: Blood tests and imaging test, complete the investigation of swallowing disorders, where deemed necessary.

Causes of swallowing disorders

Possible causes of swallowing disorders are summarized in Tables 1 & 2.

Table 1: Causes of acute disorder of the swallowing mechanism
1.Upper respiratory tract infections
e.g. aphthous stomatitis, acute pharyngotonsillitis, acute epiglottitis
2.Abscesses in the head and neck area
e.g. peritonsillar abscess, paliopharyngeal abscess
3.Ingestion of foreign bodies
4.Inhalation / ingestion of caustic substances
5.Complication of adenoidectomy / tonsillectomy
6.Radiotherapy / chemotherapy
8.Psychological causes
Table 2: Causes of chronic disorder of the swallowing mechanism
1.Diseases in the head and neck area:
– Benign and malignant neoplasms
– Paralysis of the larynx
– Esophageal diverticula
– Damage to the cervical spine
2.Diseases of the chest:
– Laryngopharyngeal reflux
– Benign and malignant neoplasms
3.Neuromuscular disorders
4.Autoimmune diseases e.g. Sjögren's syndrome
5.Systemic diseases e.g. iron deficiency anemia
6.Psychological causes
7.Old man

Treatment for swallowing disorders

The treatment of swallowing disorders must, where possible, be etiological, either by taking appropriate medication or by performing the necessary surgery. In the cases of neurodegenerative diseases, where etiological treatment is not possible, we administer supportive treatment, with appropriate feeding preparations or proceed to ensure alternative feeding routes (nasogastric feeding tube or gastrostomy).

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