What is normal swallowing?

The human body has an intricate arrangement of muscles responsible for swallowing. Food and liquid first pass through the mouth, requiring careful movements of the tongue. As they pass into the throat, or “pharynx,” the swallowing reflex is activated. Key components include bringing the voicebox higher in the neck, closing the vocal folds tightly together to prevent food from entering the airway, contracting the muscles of the throat to push the food down, and relaxing the muscle at the top of the esophagus (CP or “cricopharyngeus”) to allow food to pass. The esophagus then carries food into the stomach, where digestion begins.

Who has difficulty swallowing?

People may develop difficulty swallowing for a wide variety of reasons. Sometimes the problem lies in the mouth, from pain in the teeth or tongue or problems using the muscles. Other times there are changes in the throat, such as weakness or damage to the throat muscles from aging or a recent stroke. Occasionally patients develop thickening of the CP muscle at the top of the esophagus, which prevents food from passing normally. Frequently the source of the trouble is found in the esophagus where there can be a blockage of the esophagus itself or changes to the muscle of the esophagus.

How to swallow more easily?

Treatment of swallowing problems relies on an accurate diagnosis. People with trouble swallowing can benefit from an office scope exam to look for problems in the voicebox or throat, and an office swallowing test can be done simultaneously. This test, called FEES (“Fiberoptic Endoscopic Evaluation of Swallowing”), involves eating solid and liquid food while the throat is visualized with a scope.

Imaging studies may be requested depending on the nature of the disorder. Some patients will have a MBSS (“Modified Barium Swallow Study”) where X-rays are taken while swallowing foods and liquid covered in barium. Other patients may have an esophageal X-ray or CT scan of the neck. Colleagues in Gastroenterology and Speech and Language Pathology may be involved in your care. Some patients benefit from swallowing therapy, while others need surgery or medicines.

Contact Dr. Feinstein at the Tarzana office to learn more.