October 14, 2016

Swallowing Problems

Swallowing Problems


Swallowing problems many times are a complex set of issues.  Peak ENT physicians and staff are experts in solving swallowing problems.

How do we swallow?

The swallowing mechanism involves a series of highly coordinated muscle movements. These movements can be divided into 4 phases:

1. Oral preparatory phase: food is chewed and mixed with saliva, forming into a cohesive collection called a “bolus.” This bolus is positioned on the tongue for the next phase.

2. Oral transit phase: the tongue pushes the prepared bolus from front to back into the pharynx, where the next phase is automatically triggered.

3. Pharyngeal phase: an automated sequence of muscle contractions occurs which lifts the larynx and pulls it forwards, closes the vocal cords, closes a flap called the epiglottis over the vocal cords and airway, directs the food bolus towards the opening of the esophagus, and opens the sphincter at the upper end of the esophagus to allow the bolus to pass.

4. Esophageal phase: slowest phase (can take up to 20 seconds). Bolus is transferred from the upper end of the esophagus to the stomach. Gravity helps with this process, as well as coordinated muscle movements in the esophagus called peristaltic waves.

How are swallowing disorders diagnosed?

A comprehensive evaluation by an ENT doctor can often determine the cause of swallowing trouble. In addition to a thorough exam, a procedure called fiberoptic laryngoscopy will likely be recommended. During this simple office procedure, a flexible scope with camera is inserted through the nose to examine the throat and voice box. The patient may be given some different substances to swallow during this test, in which case the test is termed Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

If a cause still cannot be determined, a transnasal esophagoscopy (TNE) may be recommended. During this procedure, a specialized scope is placed through the nose and all the way down the esophagus to the stomach. Traditionally, gastroenterologists perform similar upper-GI endoscopies (Esophagogastroduodenoscopy or EGD) under sedative anesthesia which requires close monitoring and extended recovery time. Otolaryngologists with special training now perform this procedure in the office with minimal discomfort. TNE has proven useful for diagnosing esophageal disorders such as strictures (narrowing), infectious/inflammatory diseases and abnormal pre-malignant or malignant lesions at the gastro-esophageal junction (Barrett’s Esophagus and carcinomas).

Esophageal Cancer

Esophageal Cancer has the fastest growing rate of all cancers in the United States and is the seventh leading cause of cancer deaths world wide. In addition to problems swallowing, many of the early symptoms of esophageal cancer include chronic cough, hoarseness, and globus (sensation that something is stuck in the throat). Long-standing untreated or undiagnosed gastroesophageal reflux (GERD) and laryngopharyngeal reflux (LPR) are considered significant risk factors for developing cancer of the esophagus. Patients with these symptoms should undergo an esophagoscopy and/or barium swallow study for further evaluation and screening.