What is dysphagia?
Dysphagia is difficulty swallowing. The ability to safely swallow is essential for adequate nutrition and hydration and preventing food from entering your lungs. Swallowing is a complex act that involves coordinated movement of muscles that make up three primary phases of swallowing: oral phase (mouth), pharyngeal phase (throat) and esophageal phase (food tube). When there is a problem in one or more of these phases, it is called dysphagia.
What are the symptoms of dysphagia?
Patients with a swallowing disorder can experience several symptoms, including:
- Trouble forming food and liquid into a soft “ball” (bolus) in the mouth.
- A need for extra time to chew or move food or liquid in the mouth.
- Trouble pushing food or liquid to the back of the mouth.
- Food or liquid entering the airway when swallowing, causing coughing or throat clearing.
- Recurrent aspiration pneumonia.
- Feeling that something is stuck in the throat or chest after a swallow.
- Trouble with food entering the esophagus (food tube).
- Regurgitation or food coming back up after it is swallowed.
- Reflux or heartburn sensations.
How is dysphagia diagnosed?
In addition to a standard throat and voice box examination, your treatment team may ask you to complete a swallowing test. This may include a test performed in the office, where we observe how you swallow with a flexible scope in your nose (a fiberoptic evaluation of swallowing, or FEES test) or with X-rays of your neck and chest while swallowing (a modified barium swallow study, or MBS). The combination of a thorough exam and swallow study will determine if your dysphagia is due to a problem in your throat, voice box or esophagus.
Some swallowing problems may be treatable with therapy, medication or surgery. Depending on your working diagnosis, your treatment team will discuss different treatment options available.
- Reflux is treated with lifestyle modifications and medication. If your reflux is severe, or if the problem with your swallow appears to be an esophagus issue, you may be referred to a gastroenterologist for further testing and evaluation.
- Problems with vocal cord movement can often be treated to improve the safety of your swallowing.
- Zenker’s diverticulum and other problems with the cricopharyngeus muscle are often addressed with surgery. There are different surgeries available with different risks. Your treatment team will discuss which options are appropriate for you.
- Strictures in the throat or esophagus may be dilated in the operating room to improve your ability to swallow solid foods.
- Other swallowing problems are treatable with behavioral changes, swallowing strategies or modifications on the way you swallow, or with exercises given to you by a speech-language pathologist.
If conditions that are treatable with medicine or surgery are ruled out, your treatment team may recommend swallowing therapy to ensure the foods you are eating are safe and to maximize your chances of swallowing rehabilitation. Coordinated care with a gastroenterologist is often beneficial.
Johns Hopkins Swallowing Center
The Johns Hopkins Swallowing Center offers specialized swallowing evaluation, diagnosis and treatment for patients with swallowing disorders. Our multidisciplinary team of experts, including laryngologists and speech-language pathologists (SLPs), are committed in providing you with the highest-level of individualized care.