Swallowing


Swallowing, known scientifically as deglutition, is the process by which the food passes from the mouth into the esophagus, while shutting the epiglottis. If this fails and the object goes through the trachea, then choking or pulmonary aspiration can occur. Dysphagia is the medical term for the symptom of difficulty in swallowing food.

There are two symptoms that are often thought of as problems with swallowing. These symptoms are odynophagia and globus sensation. Odynophagia means painful swallowing. Odynophagia also may occur with other conditions associated with inflammation of the esophagus, for example, viral and fungal infections. Globus sensation refers to a sensation that there is a lump in the throat. The lump may be present continuously or only when swallowing. The causes of a globus sensation are varied, and frequently no cause is found.

Swallowing problems may arise from simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastro esophageal reflux disease, which occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include stroke or progressive neurological disorders, which may impair sensitivity, muscular coordination, or render individuals unable to control or move the tongue. The presence of a tracheostomy tube, vocal cord paralysis, tumors in the mouth, throat, esophagus, or surgery in the head, neck, or esophageal areas may also contribute to swallowing impairments.

Swallowing pain is any pain when swallowing a food. You may feel it high in the neck or lower down behind the breastbone. It is most often a strong feeling of uncomfortable squeezing and burning. Swallowing pain may be a symptom of a serious disorder.

Swallowing difficulty causes are either oropharyngeal or esophageal. Trouble with swallowing can also be due to the physical obstruction of the pharynx or esophagus. Benign and malignant tumors of the pharynx and esophagus, strictures of the esophagus, infiltrating diseases of the esophagus, diverticuli of the pharynx or esophagus, Congenital abnormalities of the esophagus can cause obstruction.

1.Treatment for swallowing disorder


A video fluoroscopic swallowing evaluation is an x-ray evaluation of swallowing function. A speech-language pathologist performs the study jointly with a radiologist.
Treatment for swallowing disorders will depend on the cause. Swallowing therapy includes: Exercises for swallowing muscles, changing the food habits, dilation of esophagus, endoscopy, surgery and medications.

The treatment of patients with swallowing difficulties should be individualized. The symptoms along with the physical and emotional impact upon quality of life should be assessed and considered in the development of a swallowing treatment strategy.
The goals of treatment for swallowing problems are to maintain adequate nutritional intake and to maximize airway protection. Rehabilitation therapy is the main stay of dysphagia management and allows for safe swallowing.

The most common infiltrating disease causing trouble swallowing food is eosinophilic esophagitis which usually is successfully treated with swallowed corticosteroids. Diverticuli of the pharynx and esophagus usually are treated surgically by excising them. They can be treated endoscopically. Cricopharyngeal bars are treated surgically by cutting the thickened muscle. Congenital abnormalities of the esophagus usually are treated surgically soon after birth. Esophageal dilation is used for a tight esophageal sphincter or an esophageal stricture.

2.Treatment Swallowing obstruction


Treatment for obstruction of the pharynx or esophagus requires removal of the obstruction. An esophageal food bolus obstruction s a medical emergency, some require the use of endoscopy to push the obstructing food into the stomach, or remove it from the esophagus.

Tumors usually are removed surgically although occasionally they can be removed endoscopically, totally or partially. Radiation therapy and chemotherapy also may be used particularly for malignant tumors of the pharynx and its surrounding tissues. If malignant tumors of the esophagus cannot be easily removed or the tumor has spread and survival will be limited, swallowing can be improved by placing stents within the esophagus across the area of obstruction. Occasionally, obstructing tumors can be dilated the same way as strictures. Throat problems including sinusitis can also cause difficult in swallowing.

Strictures and Schatzki's rings usually are treated with endoscopic dilation, a procedure in which the narrowed area is stretched either by a long, semi-rigid tube passed through the mouth or a balloon that is blown up inside the esophagus. The most common infiltrating disease causing dysphagia is eosinophilic esophagitis which usually is successfully treated with swallowed corticosteroids

Diverticuli of the pharynx and esophagus usually are treated surgically by excising them or by opening them up widely to the esophagus so that food does not collect in them. Occasionally they can be treated endoscopically. Cricopharyngeal bars are treated surgically by cutting the thickened muscle. Osteophytes also can be removed surgically. Congenital abnormalities of the esophagus usually are treated surgically soon after birth so that oral feeding can resume.
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