Dysphagia: Difficulty with Swallowing, Coughing when Swallowing, and Choking when Swallowing.

Dysphagia is the medical term for difficulty with swallowing. This difficulty may manifest as sticking of solid food as it passes through the throat or oesophagus (the tube between the throat and the stomach), or it may manifest as choking or coughing when swallowing solid food or fluid. Sticking of solid food may be caused by a narrowing of the swallowing passage or incoordination of the swallowing muscles, or by inflammation of the throat or oesophagus. Choking or coughing with swallowing solids or liquids may occur owing to aspiration, when the swallowed material touches the vocal folds, or enters the lower airway (trachea or windpipe). This is a concern as aspiration may cause chest infection. Choking or coughing with swallowing may be caused by a narrowing of the swallowing passage or incoordination and/or weakness of the swallowing muscles, or by neurological problems.

How do we evaluate dysphagia?

People with swallowing difficulties are initially evaluated by taking a thorough medical history and by performing an examination of the aerodigestive tract, including endoscopy. There are two types of endoscopy: standard endoscopy of the throat (including the larynx or voicebox) or  transnasal oesophagoscopy (TNO). Both procedures involve the passage of an endoscope (a slim tube with a camera on the end) through the nose using local anaesthetic. Both are performed in the office. Additional investigations for swallowing disorders may include: a barium swallow, a modified barium swallow (also known as a VFSS) and oesophageal manometry.

A barium swallow is an x-ray recorded on video while you are swallowing barium, a thick white liquid. This x-ray evaluates the general structure of the throat and oesophagus, and the function of the muscles of swallowing, and is undertaken by a Radiologist in a Radiology facility. A modified barium swallow is a similar x-ray examination undertaken by a Speech Language Therapist (SLT) in a Radiology facility. Oesophageal manometry is an investigation in which a very thin tube called a catheter is passed through the nose into the throat and is then swallowed. The catheter comes out of the nose and is connected to a machine that measures pressures in the throat and oesophagus while swallowing. This is undertaken by a Gastroenterologst in a Gastroenterology office.

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