Peter Belafsky, MD, MPH, PhD
Peter Belafsky, MD, director of the Center for Voice and Swallowing and a professor in the Department of Otolaryngology/Head and Neck Surgery at the University of California, Davis, School of Medicine.
You do it about 1,000 times a day and, if you are lucky, don’t think about it: You just swallow. But if you have started thinking about swallowing because it’s getting more difficult, you aren’t alone. Anyone who lives long enough will notice some decline in their ability to swallow smoothly and easily. For some people, it becomes a serious problem: They can’t eat well, struggle to swallow pills, and risk choking or getting food in their airways. Swallowing problems also ride along with many medical conditions that become more common with age, ranging from dementia to diabetes.
But there are things you can do to prevent some swallowing problems and ways to treat them once they arise.
To understand why swallowing problems are so common, it helps to understand how swallowing works in the first place. Most of our daily swallows are a kind of bodily housekeeping: You have to swallow many times a day just to clear the saliva that would otherwise build up in your mouth and throat.
When it comes to swallowing food and drinks, the process starts as soon as you think about eating or drinking. That starts extra saliva flowing. As soon as you put something in your mouth, a complex process that involves about 50 pairs of muscles and many nerves begins in earnest. The process happens in three phases. The first stage happens in your mouth, as your tongue and jaw move food or liquids into position for swallowing. Food gets moved around some more so that your teeth can start chewing. As you chew, the food pieces get smaller and mix with saliva to make them easier to move along.
In the second stage, the tongue moves the food or liquid to the back of the mouth. That triggers your swallowing response. Ideally, at this point, your voice box (larynx) closes tightly over your airway and your breathing stops so that the food or liquid can move safely through your throat (pharynx) without getting into your airway and lungs.
The third phase is the trip through the esophagus, the tube that carries food and liquid from the throat to the stomach.
Problems at any phase can create difficulties. To start, as we age more of us have trouble with our teeth. At ages 65 to 74, 13 percent of American adults have no remaining teeth. Among people over age 75, it’s 22 percent, according to the Centers for Disease Control and Prevention.
Tongue and cheek muscles may get weaker, also making it harder to chew. Your mouth tends to get drier with age, especially if you take certain medications, including antihistamines, decongestants, and many prescription drugs. That means bigger, drier chunks of food may head down your throat.
Meanwhile, the muscles in your voice box get thinner and weaker, changing not only your voice, but also your ability to keep food out of your airway. Also, every time you swallow, your voice box rises and presses against your spine, through your throat. Over a lifetime, that can result in scarring in the lower part of your throat, where it meets your esophagus. A web of tissue can form and narrow that passageway.
Your esophagus also can develop scar tissue. That can happen if you have gastroesophageal reflux disease (GERD), a common condition in which acid from your stomach comes up into your esophagus, causing irritation. When pills get stuck in your esophagus, it can cause even more irritation.
Many other health conditions can contribute to swallowing problems (see sidebar on page 6). Most people who have trouble swallowing food have some sort of blockage. Cancer and cancer treatments, as well as webbing caused by daily wear and tear, are some possible causes of those blockages. People who have trouble swallowing liquids are more likely to have neurological problems, such as stroke or Parkinson’s disease.
While swallowing problems are common, there are things you can do to prevent or minimize them. For example, you can:
If you are having trouble swallowing pills, foods, or liquids, it’s important to talk with your doctor. If you feel food or pills getting stuck in your throat or chest or you are coughing and choking when you eat or drink, those are important warning signs. Weight loss or repeated lung infections also can be signs of swallowing problems.
To get answers, you might see a digestive disease specialist (gastroenterologist) or an ear, nose, and throat doctor (otolaryngologist) who specializes in laryngology, disorders of swallowing and the voice box. In some communities, these doctors work at even more specialized swallowing-disorder clinics.
You might get some tests. One is an upper endoscopy, in which a tube is passed down your throat to take pictures of your esophagus, stomach, and part of your small intestine. In another kind of endoscopy, the tube goes down your nose, allowing the doctor to watch up-close images while you swallow.
Another test is a special x-ray called fluoroscopy that can track food as it moves through your mouth, throat, and esophagus.
Most swallowing disorders are treatable. Different causes will call for different treatment.
If your problem is a narrowed opening to your esophagus caused by webbing, a simple procedure to widen the opening can help.
If you have weak chewing muscles, you might start a mouth exercise program.
If you have GERD, treatment with antacid drugs, alginates, and lifestyle changes are in order.
You might also see a speech and language therapist, a dietitian, and other professionals.
If pills are a problem, for example, you might switch to liquid medications or use pill lubricants (available without prescription). One important caution: You should never split, crush, or otherwise change your pills without talking to your doctor or pharmacist. Some medications won’t work correctly if you alter them.
In addition to aging, here are some of the medical conditions that can cause or worsen swallowing problems:
