Difficulty swallowing, also known as dysphagia, occurs in people of all ages for a variety of reasons. Dysphagia is defined as difficulty moving food and liquid from the mouth to the stomach. Here at Mass. Eye and Ear, we are most concerned with swallowing disorders that develop in the mouth and throat. Patients who complain of food sticking in the chest are usually referred to gastroenterologists (digestive tract specialists).
Common swallowing complaints:
- Coughing or choking while eating solid food or drinking
- Liquids going down the wrong way
- Food getting stuck in the throat or a feeling that it does not go down
- Difficulty chewing
- Food or liquid coming out the nose while eating or drinking
- Difficulty swallowing medications
- Taking a long time to eat
Most common causes:
- Neurological causes such as stroke, Parkinson’s disease, brain tumors, ALS (Lou Gehrig’s disease), spinal cord problems, dementia, traumatic brain injury
- Cancer of the head and neck, including cancers of the tongue, jaw, throat, voice box (larynx), and top of the esophagus
- Respiratory causes such as chronic obstructive pulmonary disease or emphysema
- Immune, infectious, and complex medical disease
Diagnosing Swallowing Disorders
Because swallowing disorders can have such a significant impact on overall health and quality of life, we take the diagnosis very seriously.
Clinical Swallow Evaluation
Your referring doctor may request a clinical swallow evaluation where you meet with a speech-language pathologist who specializes in swallowing disorders. You will discuss the nature of your swallow problem, undergo a brief examination of how well the muscles of your mouth and throat work for speech and swallowing, and demonstrate your problem by eating and drinking some food and liquid.
You may also be referred for an examination that looks directly at your swallowing by x-ray.
Video Swallow Studies
Also known as Modified Barium Swallow studies, these are performed in our Radiology Department. Together with our speech-language pathologists, our radiologists will take an x-ray video (fluoroscopy) of you swallowing small amounts of barium liquid or pudding/cookies coated with barium. The barium contrast allows us to see the movements of the muscles during swallowing and how it flows into the esophagus (swallow tube). We also look to see if the contrast is entering the breathing tube (trachea) and why that is occurring.
During this study, which is less than five minutes, we may have you try different head postures and swallow techniques to make the swallowing more comfortable and safe.
Before this evaluation, we will review your case history and spend time discussing your concerns. Once the examination is completed, we will explain our findings and make recommendations on how to improve your swallowing. Follow-up appointments may be necessary. The entire appointment lasts about an hour.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
In this examination, a speech-language pathologist will insert the light from a narrow endoscope into your nostril and down your throat. We record the movements of the muscles of your throat as you swallow liquids and solids dyed with food coloring. You will feel some pressure as the endoscope is placed in your nose. This study lasts five to ten minutes and the results are available immediately. Recommendations are made to you and your referring doctor based on the findings.
Swallow treatment is performed in the Speech-Language and Swallowing Disorders Department at Mass General by the same team that conducts the diagnostic evaluations. Your treatment schedule will be determined together with your speech-language pathologist. Swallow exercises may be prescribed for you to do at home. You may practice your swallow techniques while eating and drinking during your treatment session.
To schedule an appointment, request one online or call 617-573-3557 today. You can reach the Voice and Speech Laboratory at 617-573-4050.