What Is Oropharyngeal Dysphagia?

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Oropharyngeal dysphagia refers to a disorder in which you cannot properly swallow food, liquid or saliva. This is a serious condition and it is essential that you seek medical care if you experience difficulty swallowing. Read on to find out more about the signs, causes, and treatment for oropharyngeal dysphagia.

Healthcare worker checking man's throat

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What Is Oropharyngeal Dysphagia?

Dysphagia or swallowing disorder is characterized by the dysfunction of one or more parts of the swallowing apparatus.

The swallowing apparatus begins with the mouth and includes the:

  • Lips
  • Tongue
  • Oral cavity
  • Pharynx (throat)
  • Airway
  • Esophagus and its sphincters

In oropharyngeal dysphagia, you have trouble moving food, liquid, or saliva from your mouth into your throat.

Signs

When you have difficulty swallowing, you may be experiencing one or more of the following symptoms:

  • Increased effort to move food and liquids from the mouth into the upper throat (pharynx).
  • Increased effort or resistance moving food from the upper throat (pharynx) into the lower throat (esophagus).
  • Food and/or medication getting stuck.
  • Regurgitation of food (can be right away with swallowing or delayed).
  • Coughing and/or choking with eating and drinking.
  • Weight loss due to food avoidance.

If you are having a hard time swallowing, you should seek medical help right away.

Who Is at Risk for Oropharyngeal Dysphagia?

Oropharyngeal dysphagia is a highly prevalent clinical condition in older age, which affects up to 13% of the total population aged 65 years and older and 51% of institutionalized older persons.

Loss of muscle mass and function, a reduction of tissue elasticity, changes of the posture, reduction of saliva production, and impaired dental status all increase the susceptibility to dysphagia and may act as a contributing factor.

Causes

As swallowing is a complex process, involving your brain, nerves, and muscles there are many reasons why oropharyngeal dysphagia can develop.

Physical Changes

Dysphagia is a relatively common secondary complication that occurs after acute cervical spinal cord injury. One small study found 30.9% of individuals with acute cervical spinal cord injury suffered from dysphagia.

In rare cases, bony changes to the cervical spine (the part of the spine that supports the neck) called bone spurs can press on the esophagus and cause swallowing problems.

Neurological Disorders

Damage to the nervous system (in the brain and spinal cord) can interfere with the nerves responsible for starting and controlling swallowing.

Some neurological causes of dysphagia include:

Parkinson's and Oropharyngeal Dysphagia

Parkinson’s disease (PD) can cause the muscles in the jaw and face to become stiff which affects the control of chewing and swallowing. The incidence of oropharyngeal dysphagia in PD is very high, with as many as 80% of patients with PD developing dysphagia during the course of their disease.

A systematic review showed that patients with PD developed oropharyngeal dysphagia approximately three times more than healthy elderly people.

Cancer

Some cancers—such as laryngeal cancer or esophageal cancer—can cause obstructions that make swallowing difficult. Radiotherapy for head and neck cancers may also cause scarring that can result in dysphagia.

Muscle Weakness

Myasthenia gravis (MG) is a neuromuscular disorder that causes gradual progressive weakness of the skeletal muscles —the muscles that allow the body to move.

Myasthenia gravis can cause symptoms in the face and throat muscles, causing problems with eating, drinking, and/or taking medication. It affects swallowing and causes a person with the condition to choke more easily. 

Diagnosis

If you suspect you have dysphagia or swallowing problems, you must see your doctor right away. Dysphagia can be dangerous, and getting an accurate diagnosis is essential.

Your doctor may refer you to an ear, nose, and throat (ENT) doctor or a gastroenterologist (GI). You may also be referred to a speech-language pathologist (SLP) who is a specialist in dysphagia and swallowing management.

Tests and measures that your doctor may perform to diagnose your dysphagia may include:

  • In-office clinical examination: Your doctor will look and listen as you swallow to determine which muscles are working properly or are impaired.
  • Barium swallowing exam with videofluoroscopy: During this examination, an X-ray will be taken of your swallowing mechanism as you swallow barium. The barium is opaque on the X-ray, and your doctor can assess where it goes in your mouth and throat as you swallow. The examination can be captured on video in real-time for review.
  • Fiberoptic endoscopic examination of swallowing (FEES): A FEES entails having a small flexible fiberoptic tube inserted into your nasal cavity. A tiny camera is on the end of the tube. Your nasal area may be anesthetized prior to insertion of the tube. Once the camera is situated up your nose and into the back of your throat, you eat bits of food, and your doctor can see where food or drink is getting caught while you swallow. The test can be recorded on video for later review.

After one (or multiple) tests, your doctor may be able to determine what is happening in your mouth and throat to cause your dysphagia.

Treatment

If you are diagnosed with oropharyngeal dysphagia, your doctor will refer you to a specialist for treatment. Your initial treatment should be to focus on the primary cause of your dysphagia.

If you have a tumor blocking your esophagus, your initial treatment will likely be the removal of the blockage. If neurological issues are causing your swallowing difficulty, treating these may ease the dysphagia.

Once the primary problem is mitigated, you may still have some swallowing difficulty, and you may need to work with a specialist to fully recover normal swallowing function.

Dietary Changes

A dietician can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you're getting the support you need at mealtimes.

Some people require soft or pureed foods. Others may simply need to take smaller bites of food. Dietary changes should focus on alleviating the difficulties of dysphagia while allowing for adequate nutrition and maintaining a person's pleasure in eating.

Dilation

Balloon dilatation is a widely accepted technique in the management of esophageal and other types of gastrointestinal narrowings, but it is rarely used for the treatment of oropharyngeal dysphagia.

Surgery

Unless the cause of oropharyngeal dysphagia is due to a blockage that can be surgically removed, surgery is not a common treatment for the condition. As many cases of oropharyngeal dysphagia are due to neurological conditions, surgery would not be an effective treatment.

Physical Therapy

Therapies designed to improve swallowing are focused on strengthening muscles and building coordination of the nerves and muscles involved in swallowing. Working with a speech-language practitioner to exercise your swallowing muscles is the best way to improve your ability to swallow.

Complications

Dysphagia can sometimes lead to further medical problems. One of the most common complications is coughing or choking when food goes down the "wrong way" and blocks your airway. This can lead to chest infections, such as aspiration pneumonia, which requires urgent medical treatment.

Aspiration pneumonia can develop after accidentally inhaling something, such as a small piece of food.

Warning signs of aspiration pneumonia include:

  • A wet, gurgly voice while eating or drinking
  • Coughing while eating or drinking
  • Difficulty breathing

Dysphagia may mean that you avoid eating and drinking due to a fear of choking, which can lead to malnutrition and dehydration, which left untreated could endanger life.

A Word From Verywell

Dysphagia and swallowing difficulties can be a scary experience and can leave you feeling anxious about consuming food. If you feel you have dysphagia or problems with swallowing, check with your doctor right away as it may be the symptom of an underlying condition that needs treatment. Many swallowing problems can be managed well with a combination of nutritional and physical therapies.

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