You Ask , They Answer
: In which cases do swallowing problems turn into a medical condition ?
: Swallowing problems are of medical concern when they become persistent and progressive . One should consider seeking medical attention early especially when there are accompanying symptoms of pain during swallowing , regurgitation , vomiting , or coughing or when there is a presence of blood-stained phlegm , change in voice , shortness of breath , or weight loss .
: How are swallowing problems managed ?
: Investigations and treatment options will depend on the cause .
Swallowing is a complex and coordinated process . There are three stages in swallowing : oral , pharyngeal , and oesophageal . Damage to any of the muscles and nerves involved in swallowing can lead to dysfunction in one of these stages .
For example , in the case of problems with tongue innervation affecting tongue movement , issues forming a proper bolus and problems with moving the bolus towards the oropharynx may arise .
If there is a dysfunction in the pharyngeal phase , food may penetrate the vocal folds and enter the airway resulting in pneumonia .
During the oesophageal phase , stomach contents can be regurgitated into the oesophagus if the lower oesophageal sphincter does not stay contracted . This can cause inflammation of the oesophagus , leading to heartburn and reflux .
For patients with swallowing problems due to an underlying neurological , neurodegenerative , or muscular disorder , a comprehensive team of physicians , neurologists , speech therapists , and dietitians will be involved in managing these problems .
Swallowing assessments such as a videoflouroscopy or fibreoptic endoscopic evaluation of swallowing are common investigations performed to evaluate oropharyngeal dysphagia . These investigations will determine if one is able to safely consume food orally by testing swallowing with a range of food and fluid consistencies .
If a patient is deemed at risk of aspiration ( food going into the airway ), nasogastric tube feeding or a percutaneous endoscopic gastrostomy may be suggested . Swallowing exercises of the throat and neck may be introduced as well to aid swallowing . The use of endoscopic botulinum toxin injections may be suitable for some .
A large group of patients that I see typically describe their swallowing problems as sensing a foreign body in the throat or similarly feeling a lump when they swallow . This sensation is medically known as globus pharyngeus . The sensation commonly occurs due to acid reflux , pharyngitis , post-nasal drip , or having enlarged tonsils . A subset of patients may benefit from speech therapy or a course of proton pump inhibitors .
For patients with post-nasal drip , treatment options will involve a trial of antihistamines , intranasal steroidal sprays , and nasal douche . Allergy testing may be introduced for those who report symptoms of itchy , runny nose or with a background of atopy ( relating to e . g ., eczema , asthma ). Nasal procedures may be suitable for some with persistent , recurrent symptoms despite the use of medications and allergen avoidance .
: Are there eating habits or lifestyle choices that ease the symptoms ?
: Acid reflux is a common condition and is medically termed laryngopharyngeal reflux if symptoms occur only in the throat . Contributing factors include a stressful lifestyle , anxiety , smoking , or a diet high in caffeine , alcohol , and spices .
General medical advice that can help ease globus is to avoid the above risk factors , ensure adequate hydration , rest , and maintain a healthy body weight within an appropriate BMI range .
Lastly , dysphagia may be a symptom of underlying head and neck malignancy . Smoking , betel nut chewing , alcohol consumption , and human papillomavirus ( HPV ) type 16 infection are known risk factors . Early medical attention impacts survival and prognosis .
Dr Soon Sue Rene
Dr Soon Sue Rene is an ENT surgeon at Adult & Child ENT Specialists , Farrer Park Hospital . She is one of very few in Singapore with certified fellowship training in paediatric and adult ENT conditions .
14 ISSUE 2 | 2023 GlobalHealthAsiaPacific . com