Difficulty Swallowing

What is Dysphagia (Difficulty Swallowing)?

Dysphagia (medically known as difficulty swallowing) is a condition where food or liquids get stuck, are delayed, or cause pain during the normal swallowing process from the mouth to the stomach. Over time, this condition can lead to serious health problems, social withdrawal, and a decrease in quality of life.

How Does the Swallowing Process Occur?

A normal swallowing process occurs in four phases:

1. Oral preparatory phase: Food is chewed in the mouth and prepared for swallowing.

2. Oral transit phase: The tongue pushes the food towards the throat.

3. Pharyngeal phase: Food passes from the throat into the esophagus.

4. Esophageal phase: Food descends from the esophagus into the stomach.

Any disruption in any phase can lead to a swallowing disorder.

Symptoms of Dysphagia

• Sensation of food getting stuck in the throat

• Constant need to clear the throat

• Change in voice, hoarseness

• Regurgitation of food through the nose

• Coughing or choking sensation

• Difficulty or pain while eating

• Weight loss

• Recurrent pneumonia attacks (due to aspiration)

Causes of Dysphagia

1. Neurological diseases:

• Parkinson’s disease

• Multiple sclerosis

• ALS (Amyotrophic Lateral Sclerosis)

• Stroke

• Alzheimer’s disease

2. Muscle diseases:

• Myasthenia gravis

• Scleroderma

3. Mechanical obstructions:

• Tumors

• Web (thin membrane formation)

• Zenker’s diverticulum

• Esophageal stricture

4. Reflux disease:

• Long-term gastroesophageal reflux can cause damage to the esophagus and lead to dysphagia.

5. Post-surgery or radiotherapy:

• Surgeries or radiotherapy applied to the head and neck region can impair swallowing functions.

Diagnostic Methods

1. Fiberoptic Endoscopic Evaluation of Swallowing (FEES):
The inside of the throat is observed during swallowing using a thin camera inserted through the nose.

2. Videofluoroscopic Swallowing Study (VFSS):
Swallowing phases are monitored under X-ray while the patient swallows barium-containing foods with fluoroscopy.

3. Esophagography:
Used to evaluate the shape and function of the esophagus.

4. Manometry:
Motor disorders are identified by measuring pressures within the esophagus.

5. Fiberoptic Laryngoscopy:
The throat and vocal cords are examined to detect problems during swallowing.

Treatment Methods

1. Dietary and Positioning Adjustments

• Texture-modified foods

• Small bites

• Upright sitting position

• Swallowing techniques training

2. Swallowing Therapies (Speech-Language Pathology)

• Laryngeal elevation exercises

• Mendelsohn maneuver

• Shaker exercise

• Whistle exercises

3. Medical Treatments

• Reflux treatment (medications)

• Muscle relaxants for spasm relief

4. Surgical Treatments

Can be applied depending on the type and cause of dysphagia:

– Vocal Cord Injection:

Applied to bring the vocal cord closer to the midline in cases of vocal cord mobility disorders.

– Balloon Dilation:

If there is a stricture in the esophagus, it is opened with a balloon.

– Cricopharyngeal Myotomy (Laser Dilation):

A surgery aimed at providing relaxation at the entrance of the esophagus.

– Laryngotracheal Separation:

Aims to prevent aspiration by separating the vocal cords and the trachea.

– Partial Laryngectomy:

Protective surgeries performed to prevent food from entering the lungs during swallowing.

These treatments are generally performed endoscopically (through the mouth). Open surgery may be required for some patients.

What is Considered When Deciding on Treatment?

• Patient’s general condition

• Underlying disease

• Cause of swallowing disorder

• Risk of aspiration

• Preservation of speech and breathing functions

A multidisciplinary approach is essential for patient-specific treatment planning.

Surgery Information Card (Sample Template)

How Does Dysphagia Affect Life?

Swallowing problems can be challenging not only physically but also psychologically and socially:

• Reluctance to eat in social settings

• Weight loss and malnutrition

• Speech disorders

• Risk of anxiety and depression

• Significant decrease in quality of life

When Should You Consult a Doctor for Dysphagia?

In the following situations, it is imperative to consult an ENT specialist or an expert experienced in swallowing disorders:

• Swallowing problems lasting longer than 2 weeks

• Sensation of something stuck in the throat

• Weight loss

• Recurrent lung infections

• Food/liquid leakage accompanied by coughing

Why Associate Professor Dr. Necati Enver?

• Academic experience in swallowing disorders

• Advanced techniques in endoscopic and laser surgeries

• Comprehensive evaluation and personalized treatment

• Expert multidisciplinary team in the field

• Modern medical infrastructure and advanced technology

Swallowing is Life

Swallowing is not only a physiological function but also a social and psychological one. Therefore, dysphagia is not merely a symptom but a serious health problem that requires treatment. Early diagnosis and personalized treatment improve quality of life and prevent complications.