Oropharyngeal Dysphagia: Symptoms, Causes & Treatment

What is Oropharyngeal Dysphagia?

Oropharyngeal Dysphagia is characterized by the inability to swallow food and liquids easily. Sometimes, people who have difficulty swallowing have their throats closed when they try to swallow and choke.

Difficulty swallowing is known as dysphagia in medical language. These symptoms do not always indicate a medical condition. This condition lasts for a short time and gets better on its own.

Difficulty swallowing is usually the result of damage or blockage in the esophagus or failure of the muscles and nerves that control the proper function of the esophagus. Dysphagia or difficulty swallowing is a problem that can come and go, be severe or moderate, and get worse over time.

If you have dysphagia, you may experience hoarseness, choking, and coughing during the first attempt to swallow food or liquids. If you have trouble swallowing, your doctor will ask questions about your symptoms to examine you.

May order various tests to detect difficulty swallowing, including GI X-rays or endoscopy. Dysphagia is treated based on the cause that develops it.

To help relieve symptoms of dysphagia, doctors advise the patient to eat small pieces of food and chew it well. Apart from this, the doctor may also suggest swallowing therapy, changes in diet, or the use of feeding tubes (a type of tube through which food is introduced into the body).

Types of Dysphagia

Swallowing is a very complex process, so there can be many reasons for difficulty in swallowing.

There are two main types of dysphagia, which develop with the following problems:

1. Mouth and Throat: This condition is called pharyngeal dysphagia.
2. Esophagus (a tube that carries food from the mouth to the stomach); The Dysphagia that occurs in this is known as esophageal dysphagia.

Symptoms of Dysphagia

The condition of dysphagia can range from mild to severe, develop repeatedly, or become worse over time. If you have difficulty swallowing, you may experience the following symptoms:

• Choking or coughing while swallowing
• Getting food or beverages back into the throat, mouth, or nose after swallowing
• Feeling like some food or liquid is stuck in your throat or chest.
• Difficulty pushing down (swallowing) food and beverages on the first try
• Weight loss because you are not able to consume enough food and fluids
• Pain while swallowing
• Feeling of pain or pressure in the chest or burning sensation in the chest

Certain types of symptoms may accompany difficulty swallowing, including:

• Drooling from mouth
• Hoarseness
• Back of food from the pharynx or esophagus
• This sensation can cause a person to skip a meal and lose appetite.

Children who have difficulty swallowing food often show the following signs:

• Refusal to eat certain types of foods
• Food and beverages leaking out of their mouth (leakage)
• Withdrawing food while eating
• Difficulty in breathing while eating
• Weight loss on its own

Causes of Oropharyngeal Dysphagia

Neurological cause

Damage to the nervous system (in the brain and spinal cord) can affect the nerves that control swallowing.

Some neurological causes of dysphagia may include:

• Stroke ( click here to read more about stroke)
• Neurological conditions that can damage the brain and nervous system over time include Parkinson’s disease, multiple sclerosis, and dementia.
• Tumors in the brain
• Myasthenia Gravis – This rare condition causes your muscles to weaken.

Congenital and developmental conditions

Here “congenital” refers to the condition you were born with, and a developmental condition affects your development.

Certain congenital and developmental conditions can cause dysphagia

Learning disabilities: In this condition, there is difficulty in learning, understanding, talking, etc.

Cerebral palsy: This is a group of mental conditions that affect the movement and coordination of the body.

Cleft of the upper lip and palate: This is a common congenital disability in which a gap between the upper lip and the palate divides them into two.

Obstruction

In some conditions, this disease can block the throat or narrow the esophagus (the tube that carries food from the mouth to the stomach) can cause difficulty swallowing.

Some cases of blockage and narrowing may include:

Oral cancer or throat cancer, such as laryngeal cancer or esophagus cancer. If they are treated, they do not cause any problems relating to swallowing.

Pharyngeal pouches: This is a large pouch that develops in the upper part of the esophagus. This pouch reduces the ability to swallow food and liquids. This is a very rare condition that occurs mainly in older people.

Radiotherapy treatment: In this therapy, scar tissue is formed, which narrows the passage of the throat and esophagus.

Gastroesophageal reflux disease (GORD): Stomach acid can also develop scar tissue and narrow your throat and stomach passages.

Infections such as tuberculosis or thrush (candidiasis of the mouth): These problems can cause inflammation and irritation of the esophagus (oesophagitis).

Muscular conditions

Any condition affecting the muscles pushing food and beverages down into the esophagus and stomach can cause dysphagia. However, here are some types of situations:

Scleroderma: In this condition, the immune system starts attacking healthy tissues, causing stiffness in the throat and esophagus muscles.

Achalasia: This condition causes the muscles of the esophagus to relax and lose their ability to open up to drain food.

Risk factors 

Old age: With age, the muscles used in swallowing tend to weaken. This is why dysphagia is a common problem in older people.

Lung disorders: Chronic obstructive pulmonary disease (COPD) is a group of lung problems that make it difficult to breathe properly. Difficulty in breathing sometimes also causes difficulty in swallowing.

Cancer surgery: Dysphagia sometimes develops as a head or neck surgery time complication.

Prevention of Oropharyngeal Dysphagia

Prevention of dysphagia is possible only if the conditions that cause it can be prevented. Many chronic neuromuscular conditions and diseases of the connective tissues cannot be prevented.

Gastroesophageal reflux disease (GERD) can be prevented with the help of medicines.

Diagnosis of Dysphagia

Tell the doctor about your symptoms during the test and when they started. Your doctor will do a physical exam during which they check for any cavity, swelling, or any other abnormality in the mouth.

More specialized tests may also be needed to find out the exact cause. These include:

Barium x-ray

Barium X-rays are usually used to check for blockages and other abnormalities inside the esophagus. During the test, you are given a special type of liquid or capsule containing a special type of dye, which you must swallow. This dye goes into the abdomen and shows up separately in X-rays. The doctor examines the function of the esophagus with the help of dye in the X-ray image and identifies any abnormalities.

Endoscopy

Endoscopy may also be used to examine the inside of the esophagus. During this test, the doctor inserts a flexible tube into your esophagus with a camera and light in front of it. This allows the doctor to see the esophagus and thoroughly examine the report.

Manometry

Manometry is another invasive test that can examine the inside of the throat. The test checks the pressure of the muscles in your throat, especially when you swallow When the muscles contract, the doctor inserts a tube into your neck to check the pressure.

Fluoroscopy

With its help, those stages of the mouth, pharynx, and esophagus are seen and used in swallowing. During this test, you are given a variety of liquids to swallow, from puree to hard and thin to thick liquids. It helps the doctor locate the food’s position coming down into the stomach and the liquid going into the trachea (air tube). The doctor can use this information to test for muscle weakness and other disorders.

Inhibition and pH Test

With the help of this test, it is determined whether acid reflux is the cause of difficulty in swallowing.

Treatment of Oropharyngeal Dysphagia

Treatment of Dysphagia depends on its cause. Treatment may include:

Exercises for the swallowing muscles of the mouth

If you have any brain, nerve, or muscle problems, you may need to practice making them work together to complete the swallowing process. You may also need to learn about the correct position of the body to eat and how to put the food in the mouth to swallow properly.

Changing foods

Your doctor may also ask you to consume certain foods and drinks that are easier to swallow.

Dilation

In this treatment, the doctor carefully inserts an instrument into your esophagus that opens up the narrowed passages. This may require you to have more than one treatment.

Endoscopy

Sometimes, a long and thin scope is used to remove any objects stuck in your throat.

Surgery

If a tumor has developed in your esophagus that is blocking the passageways, surgery may be needed to remove it. People who have a problem affecting the muscles below the esophagus may also require surgery to treat them.

Medicines

Suppose the problem of dysphagia is associated with gastroesophageal disease, heartburn, or esophagitis (swelling and irritation in the esophagus), etc., then with the help of medicines. In that case, stomach acid can be prevented from entering the esophagus. Infection conditions in the esophagus are often treated with antibiotics.

In some severe cases, you may even need to be admitted to a hospital where you can be given food through tubes. This special type of tube goes directly into the stomach instead of inside the esophagus. A special diet is taken directly by the doctor until the problem of difficulty in swallowing improves. With its help, the problem of dehydration and malnutrition is prevented.

If you have problems with chewing or swallowing, there are things you can do to make this process a little easier, including:

Positioning

• Sit straight and at a 90-degree angle
• Tilt your head forward
• After eating, sit in the same position for 15 to 20 minutes or stand up straight.

Dining environment

• Keep distracting things away from where you eat
• While eating, keep full focus on the food
• Don’t speak when food is in your mouth

Quantity and rate

• Eat slowly
• Eat food by breaking it into small pieces and chewing it well. Chew the food until it becomes liquid by mouth.
• Try not to eat more than half a teaspoon at a time.

Swallowing

• It would help if you swallowed every bite of each meal two to three times
• If some food or liquid sticks to your throat, cough slowly and then clear it and swallow it again before breathing in, repeating this process if necessary.

Management of saliva

• Drink plenty of fluids
• Have lemon or ice occasionally, or drink lemon water as it increases saliva production. Saliva helps with swallowing.

Soft diet

• Minimize the intake of such food which is difficult to chew, and eat more and more soft foods
• Make a puree (bharta) of the food with the help of a blender before eating it.
• If thin liquids cause you to cough, mix them with some other food and make them thick.

Taking medicines

• Grind the medicines and mix them in the puree of food.
• Be sure to ask your pharmacist about which medicines are not in powder and which are purchased in their liquid form in place of tablets.

Complications of Dysphagia

• Due to difficulty in swallowing, individuals are unable to consume enough food and fluids, due to which problems like malnutrition and lack of water in the body (dehydration) start.
• Difficulty swallowing can also lead to the inability to take necessary medications, leading to other medical problems.
• In this condition, the food often goes in the wrong path in the body towards the lungs instead of the stomach. This condition causes problems like suffocation or pneumonia in the throat.