When you swallow, you are chewing food and moving it to the esophagus, a tube that connects to the stomach. Dysphagia, the medical term for difficulty swallowing, is characterized by the sensation of food or liquid getting stuck in the throat or chest. There are numerous factors that can cause swallowing difficulty, most of them fairly benign.
The Swallowing Process
Few of us give much thought to the act of swallowing, but it’s actually a complex process that involves around 50 pairs of muscles and nerves.
There are four stages that make up the swallowing process:
- Stage 1: Oral preparation stage. Food is chewed to prepare for swallowing.
- Stage 2: Oral stage. The tongue pushes food or liquid to the back of the mouth.
- Stage 3: Pharyngeal stage. Food or liquid passes through the pharynx into the esophagus.
- Stage 4: Esophageal stage. Food or liquid passes through the esophagus and enters the stomach.
Symptoms & Causes
Swallowing disorders indicate persistent problems with chewing and swallowing. The main symptoms are discomfort when swallowing, chest pain and the feeling that food or liquid is getting stuck in the throat or chest. Additionally, you may experience drooling, heartburn, nausea, wheezing, coughing, regurgitation, sore throat and a sour taste in the mouth.
Causes of dysphagia are diverse. They may originate in the esophagus and include diffuse spasm, an improperly relaxed sphincter, weak esophageal muscles, a narrow esophagus or esophageal ring, the presence of foreign bodies, gastroesophageal reflux disease (GERD), a hardening of the tissues called scleroderma and tumors. In addition, the muscles and nerves responsible for swallowing can weaken as a result of neurological disorders, pharyngeal diverticula or cancer. Children may have difficulty swallowing if they suffer from certain nervous system disorders or a cleft palate.
Treatment for swallowing disorders depends on the underlying cause and where the problem originates. Medication, surgery and swallowing therapy are the most common types of treatments administered. Medications include antacids, muscle relaxants and drugs to limit the amount of stomach acid produced. A surgical procedure to stretch or dilate the esophagus when it is too narrow often helps resolve the issue. Swallowing therapy involving chewing and swallowing techniques can help stimulate the muscles and nerves responsible for swallowing. The most severe cases of dysphagia may require a liquid diet or feeding tube.
Sleep apnea is a disorder in which breathing is interrupted periodically throughout the night. These pauses, or gaps, in breathing may be accompanied by choking or gasping but rarely awaken the sleeping individual. An estimated 18 million Americans suffer from sleep apnea, many of them unaware of their condition.
There are two main types of sleep apnea: obstructive and central. Obstructive sleep apnea occurs when the throat muscles relax and droop during sleep, blocking the airway and causing breathing difficulty. It is by far the most common form of the disorder. Central sleep apnea is the result of the brain failing to properly control breathing during sleep; this is rare.
The main sign of sleep apnea is chronic, loud snoring. Symptoms include daytime drowsiness, lack of concentration, memory loss, irritability and depression. You may experience frequent morning headaches and sore throats and wake up with a dry mouth. Those who are male, overweight and older than the age of 40 are most at risk, though sleep apnea can – and does – affect people of both sexes and all ages. Other factors that can contribute to sleep apnea include natural aging, excessive or bulky throat tissue, large soft palate or uvula, small jaw, large neck and oversized tonsils or adenoids. Allergies, sinus infections, tobacco use and alcohol all may play a role as well.
Sleep apnea is more than just a nuisance that robs you of sleep. Left untreated, it can lead to serious health issues such as congestive heart failure, stroke, heart attack, high blood pressure and cardiac arrhythmia. If you suspect you are suffering from sleep apnea, schedule a visit with your physician who will perform a thorough physical examination and may set up a sleep study test.
You may be able to reduce the severity of your symptoms by implementing certain lifestyle changes. Try losing weight, cutting back or eliminating alcohol (especially before bedtime) and quitting smoking. Sleeping on your side instead of your back and elevating your head may also help.
The preferred method of treatment for sleep apnea is continuous positive airway pressure (CPAP). This involves controlled bursts of air pumped into your throat while you sleep, delivered through a mask that is worn over the nose and mouth and attached to a machine. Other options for treatment include oral mouth guards that reposition the lower jaw and tongue, nasal breathing strips and surgery.
Acid reflux, or gastroesophageal reflux disease (GERD), is a chronic digestive condition that causes painful heartburn and regurgitation for millions of Americans every year. It occurs when the contents of the stomach seep backward into the esophagus.
Normally, following a meal, a valve on your esophagus – the sphincter – closes, preventing hydrochloric acid produced in the digestive process from backing up (refluxing) into the esophagus. When reflux occurs, this valve fails to seal properly, and the stomach contents flow freely into the throat and esophagus. This damages the esophageal lining and causes a variety of painful symptoms.
Other risk factors can help to exacerbate the condition. These include eating large meals or lying down afterward, eating certain foods (spicy and fatty foods, citrus, tomato, chocolate, mint, garlic and onions), drinking certain beverages (alcohol, caffeine, carbonated liquids), smoking, obesity and pregnancy.
Heartburn is most commonly associated with GERD. Also known as acid indigestion, this burning pain radiates from the stomach to the abdomen and chest, and may last for up to two hours after a meal. It is frequently accompanied by regurgitation, a sour taste in the mouth, and dyspepsia or general stomach discomfort. Other symptoms often include belching, bloating, coughing, wheezing, hoarseness and nausea.
Symptoms occur most frequently after eating, when lying down or when bending over. They are most common at night. The most common cause of GERD is a hiatal hernia, a stomach abnormality that causes the sphincter valve and upper portion of the stomach to move above the diaphragm, allowing stomach acids to reflux more easily.
An effective way to treat acid reflux is to avoid the triggers that cause painful heartburn and other symptoms. Stay away from those foods and beverages that are likely to cause a negative reaction. Change your eating habits: stick with smaller, more frequent meals, and avoid eating too closely to bedtime. Quit smoking, and ask your doctor if the medications you are taking might be responsible for your symptoms. If you are overweight, exercise to take off excess pounds. Over-the-counter antacids taken immediately after meals will help neutralize stomach acids and can prevent heartburn from occurring, or relieve the symptoms.
For serious cases that do not respond to medical treatment, surgery may be recommended.
Head & Neck Cancer
Head and neck cancers are those that grow in and around the throat, larynx, nose, sinuses and mouth. The majority of these cancers are squamous cell carcinomas that form in the cells lining the mucosal surfaces of the head and neck. They often spread to the lymph nodes, but are highly curable if discovered early.
Head and neck cancers are classified according to the area in the body where they form. They include:
- Larynx. Also known as the voicebox, this is a tube-shaped organ in the neck containing the vocal cords. It helps us speak, swallow, and breathe.
- Oral cavity. This includes the lips, tongue, gums, and mouth.
- Salivary glands. These glands produce saliva to keep food moist and help break it down.
- Pharynx. This hollow tube begins behind the nose and leads to the esophagus and trachea.
- Nasal cavity. These are the hollow spaces in the bones around the nose, where air passes on the way to the throat.
Other cancers can form in this part of the body (brain tumors, esophageal cancer, thyroid cancer, etc.) but these behave very differently and are not classified as heck and neck cancers.
The biggest risk factors for head and neck cancers are tobacco (both cigarettes and chewing tobacco) and alcohol, especially when used together. 85 percent of head and neck cancers are linked to tobacco. Other risk factors include exposure to industrial toxins (e.g., wood dust, paint fumes), dietary factors, human papillomavirus, Epstein-Barr virus, gastroesophageal reflux disease (GERD), asbestos exposure and radiation. Certain ethnic groups (particularly Chinese) are more vulnerable, as are those from Southeast Asia who chew betel nut, and South Americans who drink mate, a beverage similar to tea.
Symptoms of head and neck cancers are similar to those associated with other conditions and may seem harmless at first. Common signs include a lump or sore that doesn’t heal, persistent sore throat, difficulty swallowing and hoarseness. Other symptoms you may experience: bleeding from the mouth, swelling of the jaw, frequent congestion, sinus infections that don’t respond to treatment, headaches, earaches, facial numbness or paralysis, enlarged lymph nodes and an unexplained loss of weight.
Treatment depends upon several factors. The size and location of the tumor, its stage, and your age and health must all be taken into consideration. Our team at Eastern Shore ENT & Allergy will make a decision based on these unique factors. Options might include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of the above.
Tumors that develop in the throat, voice box, vocal cords or tonsils are referred to as throat cancer. People who smoke, use smokeless tobacco or drink alcohol are most at risk of developing this type of head and neck cancer.
Symptoms of Throat Cancer
Many symptoms of throat cancer are associated with other, less serious conditions, so don’t worry needlessly if you experience some of these signs. Make an appointment with a doctor for a thorough exam and diagnosis if any of the following symptoms are persistent:
- Chronic cough (especially if you are coughing up blood)
- Hoarseness or other changes in your voice
- Difficulty swallowing
- Lumps or sores on the neck
- Ear or neck pain
- Sore throat
- Weight loss.
Your doctor will attempt to rule out other, more common causes first. They will examine your throat with a lighted scope and likely order a biopsy if an abnormality is spotted. Imaging tests, including X-rays, CT scans, MRIs and PET scans, can help your doctor see how far your cancer has spread. Once diagnosed, the cancer will be assigned a stage (I-IV) that indicates its extent and helps determine which course of treatment to pursue.
Treatment for throat cancer depends on the tumor’s size, location and whether it has spread to other areas of the body. Radiation therapy, surgery and chemotherapy – or a combination of the three – may be employed.
Radiation therapy delivers radiation to the cancerous cells through X-rays or other high-energy beams, causing them to die. It is most effective in early-stage cancers, where it may be the only treatment necessary.
Surgery can be effective for cancers of various stages. Procedures to remove all or portions of your voice box (laryngectomy) or throat (pharymgectomy) may be necessary. If cancer has spread to the lymph nodes, a neck dissection to remove those cancerous cells may be recommended.
Chemotherapy relies on chemicals to kill cancer cells. It is often used in combination with radiation therapy for better results.
Following treatment, you may need speech therapy or swallowing therapy, depending on the procedure(s) performed.
If detected early, throat cancers have a cure rate of 90 percent. If cancer has spread to surrounding tissues or lymph nodes, it is curable in 50 to 60 percent of patients.
Call Eastern Shore ENT & Allergy at (410) 742-1567 for more information or to schedule an appointment.