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Swallowing problems: swallowing problems

Swallowing problems: swallowing problems


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Swallowing problems can be observed as a side effect of numerous diseases, but can also be due to diseases of the nervous system, a congenital disability or injuries to the head. Depending on the intensity of the swallowing problems, they are associated with more or less severe impairments to food intake, which in turn can, in the worst case, pose a considerable health risk.

Definition

Swallowing problems refer to all complaints that can occur when swallowing, regardless of whether these are due to a physical cause or a functional disorder or a psychological impairment. The medical term is dysphagia. If throat pain or sore throat is observed when swallowing, the narrower term odynophagia is also used for this.

The swallowing act

In the swallowing act, a reflex action (swallowing reflex) usually takes place after the swallowing process is deliberately triggered, with which the ingested food reaches the stomach via the esophagus, without food residues being able to penetrate into the airways. Put simply, the soft palate and the so-called upper throat seal the airways, the food slips into the esophagus and is transported to the stomach by a wavy muscle contraction. Any impairments to this swallowing act are called swallowing problems.

Symptoms of swallowing problems

Difficulty swallowing can range from the feeling of a slight lump in the throat to frequent swallowing with subsequent coughing, gagging and pain to complete failure of the swallowing act, which makes it impossible for those affected to eat. Numerous different accompanying symptoms can be observed for the different causes of the swallowing problems, which are then explained in connection with the triggering of the swallowing difficulties.

Causes

In general, swallowing problems are usually an expression of an organic impairment of the structures involved in the swallowing act, but they can also be due to disorders of the nervous system and psychological factors. Some people also have a congenital disability that leads to severe swallowing disorders. Since the swallowing problems can indicate a serious illness, a medical examination should be carried out in any case.

Infectious diseases as the cause

Numerous infectious diseases cause inflammation of the tonsils, mouth and throat mucosa, which can lead to discomfort when swallowing. Viruses from the genus of influenza viruses, parainfluenza viruses and adenoviruses are common triggers. Coxsackie viruses (often causing a cold) and herpes viruses (causing mouth rot) can also cause inflammation of the pharynx of the throat. Furthermore, systemic viral infectious diseases such as mumps or rubella often lead to inflammation of the mucous membranes in the mouth and throat, which can cause considerable swallowing problems. Typical symptoms of viral infections are accompanying fever, runny nose, cough and hoarseness. Body aches also often appear as a side effect of viral infections. In mumps, inflammation of the parotid glands is also not uncommon, which causes a clearly recognizable swelling of the face. The difficulty swallowing in viral infections is primarily caused by the swelling of the mucous membranes or tonsils (tonsils), which hinder or block the passage of food.

Bacterial infections in the mouth and throat can also lead to difficulty swallowing. This applies to direct bacterial infections of the pharynx mucosa or the epiglottis as well as to systemic bacterial infectious diseases such as scarlet fever (triggered by special streptococci) or diphtheria (triggered by Corynebacterium diphtheriae). The symptoms of the latter often initially resemble those of a flu infection. For example, with scarlet fever, fever, chills, nausea and vomiting are observed. In addition, there is a noticeable rash here. There is also often an uncomfortable tongue or mouth burning. In the early stages of the disease, the tongue is whitish and later appears clearly reddened with slightly raised papillae (so-called raspberry tongue). Diphtheria is characterized by pain when swallowing, fever, abdominal pain, body aches, cough, nausea, and vomiting. As the disease progresses, those affected usually show significant lymph node swellings. The result is a thick neck.

Inflammation of the epiglottis should also be mentioned in the case of bacterial infections, which can lead to difficulty swallowing. This potentially life-threatening disease, caused mostly by bacteria of the genus Haemophilus influenzae type B, causes the epiglottis to swell, which can lead not only to a sore throat and swallowing problems, but also to considerable breathing difficulties. In the worst case, there is a risk of complete narrowing of the airways and subsequent suffocation.

Organic causes of swallowing problems

In addition to infections, there are numerous other physical causes of swallowing problems. These range from an abscess on the tonsils to so-called esophageal diverticula (sacs of the esophagus) and inflammation of the esophagus to cancer in the area of ​​the mouth, throat and esophagus. An extended spur on the cervical spine can also affect the swallowing process. The spurs press on the surrounding tissue and cause the so-called Eagle syndrome, which among other things causes considerable swallowing problems.

Achalasia, in which the lower esophageal sphincter (lower esophageal sphincter) does not open sufficiently to allow food to pass through the stomach, is also one of the possible physical causes of the swallowing problems. Furthermore, Plummer-Vinson syndrome, which is triggered by iron deficiency, is known as a potential trigger for difficulty swallowing. The lack of essential iron leads to considerable mucosal defects, which in turn are the cause of the swallowing problems. Torn corners of the mouth and brittle nails and hair are further striking symptoms of Plummer-Vinson syndrome.

Crohn's disease is also considered a possible cause of swallowing disorders, since the chronic inflammatory disease of the digestive tract sometimes leads not only to inflammation of the mucous membranes in the large and small intestines, but also to inflammation of the mucous membranes in the area of ​​the esophagus. Diarrhea and abdominal pain are the main symptoms in Crohn's disease. Loss of appetite, nausea and vomiting can also occur as part of the disease. The relapsing course of the disease may also cause considerable joint pain and changes in the skin's appearance as so-called extraintestinal symptoms.

Disorders of the thyroid gland, such as thyroiditis (inflammation of the thyroid gland) are also known to cause swallowing disorders, whereby the swelling of the organ is usually the cause of narrowing of the swallowing tract. This applies particularly to a so-called goiter (goiter), which can develop, for example, due to iodine deficiency, an overactive thyroid or an underactive thyroid. The massive swelling of the thyroid gland not only leads to clearly visible widening of the neck circumference, but also increases the pressure on the tissue inside the neck, which can lead to discomfort when swallowing.

Neurological causes

Numerous neurological diseases are associated with difficulty swallowing, since the functioning of the nervous system is of major importance in the swallowing reflex. If, for example, the muscles of the esophagus are no longer activated with the right impulses, the required wave-like movement to remove the food can only be carried out to a limited extent or not at all. The most well-known neurological diseases that can impair the swallowing act include multiple sclerosis (MS), Parkinson's disease and dementia.

In MS, swallowing disorders can be observed, for example, when the typical focus of inflammation of the disease manifests itself in the area of ​​the brain stem and cerebellum. At the same time, those affected often show disorders of general movement coordination, eye movements, impaired vision, speech disorders and dizziness. Typical for MS are also neurological abnormalities such as tingling in the limbs. In addition, MS patients often feel exhausted and suffer from chronic fatigue.

In Parkinson's disease, swallowing disorders are usually a rather inconspicuous accompanying symptom of bradykinesis (slow muscle movement) that can generally be observed in patients. The difficulty in swallowing is mainly characterized by increased swallowing, which can lead to food residues entering the airways and thus increasing the risk of pneumonia. Typical for Parkinson's are so-called tremors (muscle tremors), rigors (muscle stiffness) and postural instability. Over time, patients often show increasing cognitive impairments, such as a significant slowdown in thinking processes.

Dementia not only leads to a significant decrease in the cognitive abilities of those affected, such as short-term memory, thinking skills and language, but also motor skills are often significantly affected. The patients seem increasingly lacking in energy, neglecting personal hygiene and other everyday tasks, losing feeling of hunger and even forgetting elementary things in the late stages of the disease, such as swallowing food or triggering the swallowing reflex. In the final stage of the disease, which is still incurable, those affected are dependent on all-day care.

Various other neurological diseases such as ALS (amyotrophic lateral sclerosis), myasthenia gravis or the so-called Huntington's disease are also to be considered as triggers of the swallowing problems, even if, fortunately, these occur very rarely. The same applies to special diseases of the spinal cord, such as syringomyelia. Brain tumors can also be considered as the cause of neurological impairments of the swallowing reflex.

In addition to massive headaches, dizziness, nausea, vomiting, balance, coordination, vision, speech and perception disorders as well as unilateral paralysis, swallowing disorders are among the possible signs of a stroke. If the brain is injured by the use of violence, the subsequent traumatic brain injury can also lead to neurological failures and corresponding swallowing problems.

Damage to the tongue-pharynx nerve (glossopharyngeal nerve; ninth cranial nerve) also sometimes leads to considerable swallowing problems, since the nerve plays an important role in controlling the so-called pharyngeal muscle and if the latter is paralyzed, the swallowing act cannot take place as intended. Possible causes of corresponding damage to the glossopharyngeal nerve are, for example, a disease of rabies, tetanus or botulism.

Allergic reaction

In the case of a food allergy, significant swelling of the mucous membranes in the mouth and throat can set in after the allergens have been absorbed, which can lead to discomfort when swallowing and, under certain circumstances, breathing difficulties. This applies in a similar way to insect venom allergy sufferers after a bee or wasp sting. In the worst case, contact with the allergens threatens life-threatening anaphylactic shock.

Difficulty swallowing due to age

All nerves, muscles, organs and connective tissue structures involved in the swallowing act - like the body as a whole - are subject to the general aging process. This can affect the swallowing act in a variety of ways. For example, the significant reduction in saliva production in older people often leads to swallowing problems. The age-related slowdown in motor processes can also cause difficulty swallowing. This applies similarly to the structural changes in the temporomandibular joint that can be observed in some elderly patients. Missing teeth or poorly fitting dentures also often lead to impairment of the swallowing act in older people.

Psychological causes

In addition to the physical causes, psychological factors can also trigger swallowing difficulties. For example, some people experience swallowing disorders as an accompanying symptom of stress, grief, fear or acute stage fright. Functional swallowing disorders are also mentioned here.

Diagnosis

According to the numerous causes that may be the reason for the swallowing difficulties, the diagnosis is often extremely difficult. First, a thorough medical history is carried out in the course of the medical examination. Subsequently, the swallowing act is usually examined more closely, as long as the description of the symptoms does not give rise to any suspicion of an acute complaint, such as a stroke. The doctor tests the mobility of the larynx and the function of the swallowing reflex, gag reflex, cough reflex and the tongue. The inspection of the mouth and throat area also provides important points of reference for the diagnosis. Most of the infections shown above can already be determined quite clearly on the basis of the tongue coating, the redness and other changes in the mucous membrane. The laboratory examination of a mucosal smear then serves to identify the pathogen.

A blood test often also provides information on the cause of the difficulty swallowing. For example, in the case of infectious diseases, there may be corresponding antibodies in the blood or increased inflammation values ​​indicate inflammatory processes in the organism. The hormone level in the blood provides indications of possible diseases of the thyroid gland and the iron content shows whether there is an iron deficiency or the Plummer-Vinson syndrome.

In addition, when diagnosing swallowing difficulties, an endoscopic examination can be carried out, in which an endoscope is inserted through the mouth or nose and allows a look inside the patient. In the context of this so-called endoscopy, it is also possible to take a tissue sample (biopsy), which is used, for example, to identify tumors or cancer. Gastroscopy (gastroscopy) is used to examine the esophagus, stomach and duodenum.

X-ray examinations and other imaging methods can also help diagnose swallowing difficulties, for example if a diverticulum or a spur on the cervical spine is suspected. Often, a slurry containing contrast medium is taken in order to detect abnormalities in the swallowing process. In this way, for example, achalasia can also be determined. Magnetic resonance imaging is also used as an imaging method to detect foci of inflammation in the brain, spinal cord and nervous system in MS. For their part, ultrasound examinations are used, for example, to diagnose thyroid disorders such as goiter, but additional examinations using computed tomography or magnetic resonance imaging may also be necessary here.

Further neurological examinations are carried out, for example, if you suspect dementia, Parkinson's disease, myasthenia gravis or ALS. If all organic and neurological causes of the swallowing difficulties are excluded, a psychotherapeutic examination is recommended in order to find out possibly existing psychosomatic causes of the swallowing problems.

Treatment for swallowing problems

First of all, treatment of the respective causes is generally required for swallowing problems. Given the multitude of possible triggers for swallowing difficulties, a description of all therapeutic approaches would clearly go beyond the scope here. However, there are some treatment options that explicitly relate to the swallowing disorders and are to be explained in more detail below. These procedures are summarized under the term swallowing therapy.

An essential part of swallowing therapy are special motor exercises, through which targeted training of the muscles and movements involved in the swallowing act is possible. In this way, for example, impairments to the seal to the nasopharynx and the associated swallowing of food can often be avoided. Overall, the exercises aim to normalize the swallowing act or the swallowing, choking and cough reflex. Exercises from the area of ​​speech therapy often play a crucial role here, since when speaking, similar muscle groups are addressed as in the course of the swallowing act.

Special massages as part of swallowing therapy should also alleviate swallowing problems. In addition, breathing exercises and posture corrections during eating are often part of the therapy. Last but not least, the consistency of the food can be adjusted as part of the treatment in order to make it easier to ingest or swallow, and thus avoid artificial feeding using a gastric tube. If, due to the swallowing problems, the patient is not able to take in enough food and liquid for a longer period of time, a tube must be placed in their stomach to ensure their nutrition. Easy-to-learn swallowing maneuvers can often significantly reduce the risk of ingestion while eating and normalize the swallowing process. The Mendelsohn maneuver, in which the larynx is held up for a short time, and the so-called supraglottic swallowing (holding your breath after swallowing, clearing your throat and swallowing again) are particularly worth mentioning here.

Swallowing therapy in no way replaces the treatment of the causes underlying swallowing difficulties, but can at best also provide additional relief. It is also often used in the treatment of illnesses (for example in stroke patients) when there are lasting disorders of the swallowing reflex. In order to increase the chances of success, swallowing therapy should ideally not only be accompanied by the treating doctors, but also by speech therapists and nutritionists.

Prevention

Since numerous infectious diseases cause inflammation of the mucous membranes in the mouth and throat, improved protection against infection indirectly prevents swallowing difficulties. Naturopathy has numerous options here that generally strengthen the immune system. Irritation of the mucous membranes, for example by smoking, increases the risk of swallowing problems and should therefore be avoided. Alcohol consumption is known as a possible cause of damage to the esophagus or esophageal cancer, which in turn can cause difficulty swallowing. In general, diet can have a significant impact on the risk of esophageal diseases. For example, foods that are particularly rich in fat, calories and protein are attributed a negative effect here. A balanced diet with a sufficient basic diet can not only contribute to reducing the risk of disease in the area of ​​the esophagus, but at the same time counteract a possible overacidification of the organism, which in turn is associated with a variety of health complaints.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Kristle Lee Lynch: Dysphagia, MSD Manual, (accessed October 8, 2019), MSD
  • J. Strutz, W. Mann: Practice of ENT medicine, head and neck surgery, 3rd edition, Thieme Verlag, 2017
  • Wolfgang Rösch: Certified medical training: Key symptom of dysphagia, Dtsch Arztebl 2004; 101: A 2748-2752 [Issue 41], (accessed October 8, 2019), aerzteblatt.de
  • National Institute of Health (NIH): Plummer Vinson syndrome, (accessed October 8, 2019), rarediseases
  • Thomas Lenarz, Hans-Georg Boenninghaus: ENT, Springer-Verlag, 14th edition 2012

ICD codes for this disease: R13, F45.8, D50.1ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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