I Can't Swallow

Did you know that each and every one of us swallows 1,000 times/day? In fact, we swallow so frequently that we generally take it for granted...until we can’t swallow easily, that is. Until we suddenly have the feeling there's a golf ball in our throat. Or that food seems to be getting stuck when we swallow. Or that food is coming back up after we thought we had swallowed it. Sometimes swallowing difficulties aren't quite that obvious...they may appear as lots of phlegm in your throat or coughing after eating. The question is: What do you do when you think you might have a hard time swallowing?

Posted on | Jonathan E. Aviv, MD, FACS | Comments ()

Did you know that each and every one of us swallows 1,000 times/day? In fact, we swallow so frequently that we generally take it for granted...until we can’t swallow easily, that is. Until we suddenly have the feeling there's a golf ball in our throat. Or that food seems to be getting stuck when we swallow. Or that food is coming back up after we thought we had swallowed it. Sometimes swallowing difficulties aren't quite that obvious...they may appear as lots of phlegm in your throat or coughing after eating. The question is: What do you do when you think you might have a hard time swallowing?


The first thing to do is to see your doctor and explain what has been troubling you. Is the swallowing problem something that began recently? Or is it something that began gradually and is getting worse and worse? Is there an underlying condition such as a recent stroke, Parkinson’s disease or even acid reflux disease? What your doctor will determine first is whether or not the swallowing difficulty is due to a problem with the throat or a problem with structures farther away from the throat such as the esophagus and stomach.


Swallowing problems that suddenly occur while eating could be due to a piece of food, a bone (chicken and fish come to mind) getting stuck in your throat while you were eating, or talking, watching the football game and reading the newspaper – all while eating. In addition, swallowing problems that begin rather suddenly are typically related to infection or inflammation that can resolve rather quickly with treatment.


In situations where the swallowing difficulty has been going on for at least 2 weeks there are 2 basic tests that can be performed to determine how best to help the patient. The 2 tests are X-ray-based tests of swallowing and endoscopy-based (non-X-ray) tests of swallowing. The X-ray tests are all variations of what is commonly known as an “upper GI series.” These GI X-ray tests (GI stands for GastroIntestinal) generally take place in a radiologist’s office and X-ray films are used to create a mini movie that tracks how barium liquid or barium-coated food (e.g., a cookie) is swallowed.


The endoscopy-based tests (non X-ray) of swallowing, commonly known as FEESST, Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (for people who have trouble feasting), or FEES, Fiberoptic Endoscopic Evaluation of Swallowing, are generally performed in the doctor’s office. With endoscopy, an ultra thin scope (the size of a strand of spaghetti) attached to a television monitor is placed via the nose into the throat and food containing green food coloring is given to the patient. We use green because green contrasts quite well against the pink tissues of the throat. One can then track how the green food travels in the throat before it is swallowed.   


Whether using X-ray or endoscopy, swallowing tests are often performed in conjunction with speech language pathologists (a misnomer because speech pathologists are often swallowing specialists too.) The speech language pathologist instructs the patient with different maneuvers (e.g., altering head position while swallowing) or altering food consistencies (e.g., thickening a liquid so that it becomes easier to swallow) to insure that the swallow is safe. By safe I mean the food doesn’t go into the windpipe during the swallow.   


No matter what type of swallowing evaluation is ultimately used (X-ray or non X-ray) the key point here is that difficulty swallowing is something that should be brought to your doctor’s attention. Don’t sit on a swallowing problem.


For more information go to www.voiceandswallowing.com.

Blog written by Jonathan E. Aviv, MD, FACS
Author of over 60 scientific papers in peer-reviewed journals and Flexible Endoscopic Evaluation of Swallowing with Sensory...