Swallowing disorder; It is a situation in which food and drinks cannot be transmitted to the stomach in a sufficient time, properly or incorrectly, due to problems in the person's throat or esophagus during the passage of food and drinks from the mouth pipe to the stomach. Swallowing disorder is medically called dysphagia. It also occurs in situations such as eating too quickly and not swallowing food properly, but this situation causes momentary swallowing disorder. Persistent swallowing disorders should be taken into account. If the food goes down to the vocal cords during swallowing, a serious condition called 'penetration' may occur, and if it goes down below the vocal cords, a serious condition called 'aspiration' may occur. Swallowing disorders can occur at any age, but it is more common in the elderly, infants, or people with diseases affecting the brain, nervous and muscular systems.
What are Swallowing Disorders (Dysphagia)?
- Mouth (Oral) Dysphagia: It is a swallowing disorder caused by a problem in the mouth. It is a condition where there is difficulty in chewing, tongue weakness and moving solid and liquid foods into the throat. It usually occurs after neurological problems (such as a stroke).
- Pharyngeal Dysphagia: Difficulty in initiating swallowing of food and beverages, pushing solid or liquid foods towards the esophagus, and closing the airway to prevent food from going the wrong way. It is a problem that occurs in the throat as a result of It usually occurs after neurological problems such as Parkinson's disease and stroke.
- Esophageal Dysphagia: It is a problem that occurs in the esophagus as a result of difficulty in opening and closing the holes in the throat and stomach while swallowing and pushing food into the esophagus. This condition usually develops due to obstruction and irritation and is treated by surgical intervention.
Causes of Swallowing Disorder
- Stroke, brain trauma, spinal cord injury, Parkinson's, Multiple Sclerosis (MS), Nervous system-related diseases such as Amyotrophic Lateral Sclerosis (ALS), Muscular Dystrophy, Cerebral Palsy, Alzheimer's
- Achalasia: It is the condition in which the lower esophagus muscles located at the lower end of the esophagus do not relax, that is, they are not rested enough to allow food to enter the stomach. These muscles sometimes e weight loss may occur. In such cases, the food comes back to the throat without being digested in the stomach.
- Mouth, throat or esophagus cancer, head and neck injury or surgery, lack of oral hygiene (missing or missing teeth, decay or unfit teeth). Swallowing disorders may occur due to head and neck problems in cases such as the use of inappropriate dental prostheses (inappropriate dentures), etc.
- Esophageal stenosis: The narrowness of the esophagus is caused by reflux, tissue injuries and tumors, and large It makes it difficult to swallow bite-sized foods.
- Foreign objects are also the cause of swallowing disorders. Sometimes food or another object can get stuck in the throat or esophagus, causing a partial blockage. Especially in the elderly and children, where the use of prosthetic teeth is common, food stuck in the throat may occur when food is not chewed well.
- In people with reflux disease, tissue damage may occur in the esophagus as a result of stomach acid escaping upwards. Returning nutrients and acids cause spasm, scars and narrowing in the lower part of the esophagus, causing swallowing difficulties.
- Radiotherapy: When radiotherapy applied in cancer treatment is applied to the head and neck area, it causes inflammation, hardening and scars in the esophagus. It may cause swallowing difficulties.
- Eosinophilic esophagitis: It is associated with food allergy. It causes the cells called 'eosinophils', which are white blood cells in the esophagus, to proliferate uncontrollably and affect the cells in the digestive system. Problems such as vomiting and difficulty swallowing occur.
- Scleroderma: It occurs when the tissues harden. As the esophageal sphincter muscle weakens, acids leak back into the esophagus and frequent heartburn occurs. This causes swallowing disorders.
- Pharyngeal diverticulum: Small sacs and food deposits in the throat and especially in the upper part of the esophagus cause conditions such as difficulty in swallowing, bad breath, the need for repeated throat clearing and coughing.
Symptoms of Swallowing Disorder
- Difficulty and pain while swallowing (odiophagia)
- Inability to swallow
- During or after swallowing Coughing and congestion during periods
- Feeling of food being stuck in the throat, chest or back of the chest
- Condition of the voice becoming wet and wheezing during or after eating and drinking
- Increased salivation
- Weight loss
- Food coming back from the nose or mouth
- Frequent heartburn and reflux situation
- Hoarseness
- Food or liquid leaking from the mouth or accumulation of food in the mouth
- Changes in eating habits
Swallowing Disorder Treatment
Swallowing disorder treatments vary depending on the underlying cause of the disease and the condition of the disease. This condition can sometimes go away on its own without any treatment. In the treatment of complex swallowing problems, it can be performed by one or more specialists. If the swallowing disorder has become permanent and the cause is not obvious, the ENT doctor, who is a specialist in the field, listens to the patient's story about the disease and examines it. During this examination, endoscopes with camera imaging systems are used. If necessary, examination of the esophagus, stomach and duodenum can be performed together with gastroenterologists. Barium x-rays of the digestive system may also be requested when deemed necessary. In some cases, a neurologist can evaluate whether the swallowing disorder originates from the nervous system.
Swallowing disorder can be treated with medication, swallowing treatment or surgical intervention. It is generally recommended that patients with swallowing disorders use medications that reduce stomach acid secretion or muscle relaxants. In cases where swallowing treatment is deemed necessary, the patient is made to perform exercises in appropriate positions to strengthen the muscles responsible for swallowing. This is called positional swallowing therapy. Patients are taught to put food in their mouths in a certain position and to position their bodies more easily for swallowing. The aim of the treatment is to ensure that food is swallowed easily and safely. Sensory techniques are also used to stimulate the nerves that can activate the swallowing reflex. A balanced diet, choosing foods that are easiest to swallow, as some foods and liquids are easy to swallow program is created.
In some cases where it is deemed necessary, surgery may be performed. If there is a narrowing or adhesion in the esophagus, this area can be widened or opened. The dilation process is an example of this. If there is a stenosis in the esophagus, the esophagus can be widened by placing and inflating a small balloon into the esophagus through dilation. If there is a problem with the muscles in the esophagus not being able to relax, then botox treatment can be applied. In cases where there is a risk of pneumonia, malnutrition or fluid electrolyte imbalance, tube feeding can also be applied by inserting a tube into the stomach.
Regulating eating habits is also important for the treatment of swallowing disorders. While eating, the head should be tilted slightly forward while swallowing, eating in a 90-degree upright position and maintaining this position for 15-20 minutes after eating, not talking while eating and eating slowly, and taking small pieces into the mouth and not swallowing without chewing well.
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