Difficulty swallowing problems

Dysphagia and dysphagia

Swallowing problems can be seen as a concomitant of many diseases, but can also be due to diseases of the nervous system, congenital disability or head injuries. Depending on the intensity of the swallowing problems, they are associated with more or less adverse effects on food intake, which in turn can become a serious health risk at worst.

contents

definition
The swallowing act
Symptoms of swallowing problems
causes
Infectious diseases as a cause
Organic causes of swallowing problems
Neurological causes
Allergic reaction
Age-related dysphagia
Mental causes
diagnosis
Treatment for swallowing problems
prevention

definition

Swallowing problems are all complaints that can occur during swallowing, regardless of whether they are due to a physical cause or a functional disorder or mental impairment. The medical term is dysphagia. If you experience throat pain or sore throat while swallowing, the narrower term odynophagia is also used.

The swallowing act

In the act of swallowing, after the voluntary triggering of the swallowing process, a reflex action (swallowing reflex) is usually taken, with which the ingested food reaches the stomach via the esophagus without the food particles being able to penetrate into the airways. Simplified, the soft palate and the so-called upper lavender seal the respiratory tract, the food slides into the esophagus and is transported here by a wave-shaped muscle contraction in the stomach. Any impairment of this Schluckaktes are referred to as swallowing problems.

Symptoms of swallowing problems

Dysphagia can range from the sensation of a slight lump in the throat to frequent ingestion followed by coughing, gagging and pain, to a complete failure of the swallowing act, making it impossible for those affected to eat. The various causes of the swallowing problems can be observed numerous different accompanying symptoms, which are then explained in each case in connection trigger triggers the swallowing.

causes

In general, swallowing problems are usually an expression of organic impairment of the structures involved in the swallowing act, but they can also be due to disorders of the nervous system and mental factors. In some people, there is also a congenital disability that leads to significant dysphagia. Since the swallowing problems can certainly point to a serious illness, a medical check-up should always be carried out.

Frequently, tonsillitis is the cause of difficulty swallowing. (Image: rob3000 / fotolia.com)

Infectious diseases as a cause

Numerous infectious diseases cause inflammation of the tonsils, oral and pharyngeal mucosa, which can lead to discomfort during swallowing. Frequent triggers are viruses of the genus influenza viruses, parainfluenza viruses and adenoviruses. Also Coxsackie viruses (often triggers a cold) and herpes viruses (triggers the oral blight) can lead to appropriate inflammation of the pharynx. 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 significant swallowing problems. Typical symptoms of viral infections include concomitant fever, runny nose, cough and hoarseness. Body aches are also common as a concomitant of viral infections. Inflammation of the parotid gland is also not uncommon in mumps, which causes a noticeable swelling of the face. In the case of viral infections, swallowing complaints are mainly caused by the swelling of the mucous membranes or tonsils (tonsils), which is the passage of the food hamper or block.

Bacterial infections in the mouth and throat can also lead to dysphagia. This applies to direct bacterial infections of the pharyngeal mucosa or the epiglottis as well as to systemic bacterial infectious diseases such as scarlet fever (caused by special streptococci) or diphtheria (caused by Corynebacterium diphtheriae). The symptoms are often similar to those of a flu infection in the latter. For example, scarlet fever, fever, chills, nausea and vomiting can be observed in scarlet fever. In addition, however, here comes a striking rash. Also often shows an unpleasant tongue or mouth burning. The tongue is white in the early stages of the disease and appears later in the course clearly reddened with slightly raised papillae (so-called raspberry tongue). A diphtheria disorder is characterized by the pain of swallowing due to fever, abdominal pain, body aches, coughing, nausea and vomiting. In addition, those affected usually show significant lymph node swelling in the course of the disease. A thick neck is the result.

Inflammations of the epiglottis are also among the bacterial infections that can lead to dysphagia. This, usually caused by bacteria of the genus Haemophilus influenzae type B, potentially life-threatening disease causes swelling of the epiglottis, which can not only cause sore throat and swallowing problems, but also to considerable difficulty in breathing. In the worst case, a complete constriction of the respiratory tract and subsequent suffocation death threatens.

Organic causes of swallowing problems

In addition to the infections numerous other physical causes in swallowing problems are considered. These range from an abscess on the palatine tonsils over so-called esophageal diverticula (esophageal eructations) and inflammation of the esophagus to cancers around the mouth, pharynx and esophagus. An extended spur on the cervical spine can also lead to impaired swallowing. The spurs press on the surrounding tissue and cause the so-called Eagle syndrome, which, among other things, brings considerable swallowing problems.

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

Also, Crohn's disease is considered a possible cause of dysphagia, as the chronic inflammatory disease of the digestive tract, sometimes leading not only to inflammation of the mucous membranes in the large intestine and small intestine, but also to mucosal inflammation in the esophagus. Diarrhea and abdominal pain are the hallmarks of Crohn's disease. Also loss of appetite, nausea and vomiting may occur as part of the disease. The relapsing disease may also cause significant joint pain and changes in the appearance of the skin as so-called extraintestinal symptoms.

Thyroid disorders such as thyroiditis (thyroiditis) are also known as the cause of dysphagia, with swelling of the organ usually causing narrowing of the swallowing tract. This is especially true in a so-called goiter (goiter), which can develop, for example due to iodine deficiency, hyperthyroidism or hypothyroidism. The massive swelling of the thyroid not only leads to externally visible enlargements of the neck circumference, but also increases the pressure on the tissue inside the neck, which can lead to discomfort during swallowing.

Neurological causes

Numerous neurological diseases are associated with dysphagia, as the functioning of the nervous system during swallowing is of major importance. For example, if the muscles of the esophagus are no longer controlled with the right impulses, the necessary wave-like movement for the removal of food can be carried out only partially or not at all. Among the most well-known neurological diseases that can cause an impairment of the swallow act include multiple sclerosis (MS), Parkinson's disease and dementia.

In MS, for example, dysphagia can be observed when the typical sites of inflammation of the disease manifest themselves in the brainstem and cerebellum. Concomitantly, in such cases sufferers often show disturbances of general coordination of movement, eye movements, impaired vision, speech disorders and dizziness. Neurological abnormalities such as tingling in the limbs are typical of MS. In addition, MS patients often feel exhausted and suffer from chronic fatigue.

In Parkinson's disease, dysphagia is usually a rather subtle concomitant symptom of common bradykinesia (slowed muscle movement). The dysphagia is mainly characterized by increased ingestion, which can lead to the ingress of food residues into the respiratory tract and in this way also increases the risk of pneumonia. Typical of Parkinson's are the so-called tremor (muscle tremors), rigor (muscular rigidity) and postural instability. Over time, patients often show increasing cognitive impairment, such as a marked slowing of thought processes.

Not only does dementia decrease the cognitive abilities of sufferers, such as short-term memory, thinking and language, but also motor skills are often seriously affected. The patients appear increasingly impotent, neglect the body care and other everyday tasks, lose the feeling of hunger and forgotten in the late stages of the disease even as elementary things, such as swallowing the food or the triggering of the swallowing reflex. In the final stage of the disease, which is still incurable today, those affected are dependent on full-time care.

Various other neurological disorders, such as ALS (Amyotrophic Lateral Sclerosis), Myasthenia Gravis, or Huntington's Disease, are also considered to be the cause of swallowing problems, although fortunately these are rare. The same applies to special diseases of the spinal cord, such as syringomyelia. Brain tumors are also considered to be the cause of neurological impairments of the swallowing reflex.

In addition to severe headache, dizziness, nausea, vomiting, balance, coordination, vision, speech and perception disorders, as well as unilateral paralysis, difficulty swallowing is one of the possible signs of a stroke. If the brain is injured by force, it may also come in the course of the subsequent craniocerebral trauma to neurological deficits and corresponding swallowing problems.

Damage to the tongue and throat nerve (Nervus glossopharyngeus, Ninth cranial nerve), sometimes also leads to significant swallowing problems, as the nerve performs an essential function in the control of the so-called pharyngeal muscle and in a paralysis of the latter, the swallowing can not be done as planned. Possible causes of corresponding damage to the glossopharyngeal nerve include, for example, rabies, tetanus or botulism.

Allergic reaction

In the case of a food allergy, clear swelling of the mucous membranes in the mouth and throat can occur after ingestion of the allergens, leading to discomfort during swallowing and possibly to breathing difficulties. This applies similarly to insect venom allergies after a bee or wasp sting. In the worst case, exposure to the allergens threatens a life-threatening anaphylactic shock.

Age-related dysphagia

All nerves, muscles, organs and connective tissue structures involved in the onset of swallowing are - like the body as a whole - subject to the general aging process. This can cause impairments of the swallowing act in many ways. For example, the significant reduction in saliva production in the elderly often results in difficulty swallowing. Also, the age-related slowing of motor processes can cause dysphagia. This is similarly true for the structural changes of the temporomandibular joint seen in some elderly patients. Missing teeth or a badly fitting dentures also often lead to impaired swallowing in older people.

Mental causes

In addition to the physical causes and mental factors as the trigger of the swallowing symptoms into consideration. For example, in some people, dysphagia is a symptom of stress, grief, anxiety or acute stage fright. Here is also talk of functional swallowing disorders.

diagnosis

Depending on the numerous causes that may underlie the dysphagia, the diagnosis is often extremely difficult. First, a thorough medical history is done during the medical examination. Subsequently, the swallowing act is usually examined in more detail, as long as the symptom description 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. Also, the inspection of the oropharynx provides important clues to the diagnosis. Most of the infections described above can already be determined quite clearly on the basis of the tongue coating, the reddening and other mucosal membrane changes. The laboratory examination of a mucosal smear then serves to identify the pathogens.

On the basis of a blood test, there are often indications of the cause of the dysphagia. Thus, for example, in the case of infectious diseases corresponding antibodies in the blood or increased inflammatory levels indicate inflammatory processes in the organism. The hormone level in the blood provides evidence of possibly existing diseases of the thyroid gland and the iron content shows whether iron deficiency or the Plummer-Vinson syndrome could be present.

Furthermore, when diagnosing dysphagia, an endoscopic examination may be performed in which an endoscope is inserted through the mouth or nose and allows a view of the patient's interior. Within the scope of this so-called endoscopy, it is also possible to take a tissue sample (biopsy), which serves, for example, to detect tumors or cancerous diseases. Gastroscopy is used to examine the esophagus, stomach and duodenum.

X-ray and other imaging techniques can also help diagnose dysphagia, such as suspected diverticula or cervical spine. Often this involves the intake of a contrast agent mixed with pesticides to detect abnormalities in the swallowing process. In this way, for example, an achalasia can be detected. Magnetic resonance imaging also serves as an imaging method for the detection of inflammatory foci in the brain, spinal cord and nervous system in MS. For example, ultrasound scans are used to diagnose thyroid problems such as goiter, but complementary scans using computed tomography or magnetic resonance imaging may be required.

Further neurological examinations are carried out, for example, in suspected dementia, Parkinson's disease, myasthenia gravis or ALS. If all organic and neurological causes of dysphagia are excluded, a psychotherapeutic examination is recommended in order to find out about possible psychosomatic causes of the swallowing problems.

Treatment for swallowing problems

First of all, the swallowing problems require treatment of the respective causes. In view of the large number of possible triggers of swallowing symptoms, however, a description of all therapeutic approaches would go beyond the scope of this article. However, there are some treatment options that explicitly refer to the dysphagia and are then explained in more detail. These procedures are summarized under the term swallowing therapy.

An essential part of the swallowing therapy are special motor exercises, through which a targeted training of the muscles and movements involved in the swallowing act is possible. In this way, for example, impairments of the seal to the nasopharynx and the associated ingestion of food can often be avoided. Overall, the exercises aim at a normalization of Schluckaktes or the swallowing, choking and coughing reflexes. Exercises in the field of speech therapy often play a decisive role in this, as speaking similar muscle groups are addressed as in the course of the swallowing act.

Special massages are also supposed to relieve swallowing problems as part of the swallowing therapy. In addition, breathing exercises and corrections of posture 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 facilitate the intake or swallowing and thus to avoid an artificial feeding by gavage. Because patients are unable to absorb enough nutrients and fluids for a long time because of their swallowing problems, they must be given a probe in their stomach to ensure their nutrition. Easy-to-learn swallowing maneuvers often reduce the risk of swallowing in the course of food intake and normalize the swallowing. Here are mainly the Mendelsohn maneuver, in which the larynx is held up for a short time, and the so-called supraglottic swallowing (stopping the air after swallowing, clearing throat and swallowing again) to mention.

The swallowing therapy does not replace the treatment of the causes underlying the difficulty swallowing, but can at best contribute to the relief. In addition, it is often used in the aftercare of diseases (for example in stroke patients), if sustained disturbances of the swallowing reflex are present. In order to increase the chances of success, the swallowing therapy should ideally be accompanied not only by the attending physicians, but also by speech therapists and nutrition therapists.

prevention

Since numerous infectious diseases cause inflammation of the mucous membranes in the mouth and throat, improved infection protection indirectly leads to an avoidance of swallowing symptoms. Naturopathy offers numerous options that generally strengthen the immune system. Irritation of the mucous membranes, for example through 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 may cause dysphagia. In general, the diet can have a significant influence on the risk of esophageal diseases. For example, foods containing fat, calories and protein are ascribed a negative effect here. However, a balanced diet with adequate basic diet can not only reduce the risk of disease in the esophagus, but at the same time counteract any possible acidity of the organism, which in turn is associated with a variety of health conditions. (Fp)