Difficulty in swallowing (Dysphagia)

Written by: Professor Guri Sandhu
Published: | Updated: 26/03/2019
Edited by: Laura Burgess

Dysphagia is a difficulty or derangement in normal swallowing, which can range from a minor sensation of something persisting in the throat, to coughing during feeding, to having to constantly spit out saliva.

Causes of swallowing problems

The exact incidence of dysphagia is unknown as it has so many different causes, such as:

  • Neurological conditions (including stroke)
  • Ageing Caustic (bleach) ingestion and strictures from acid reflux
  • Head, neck, oesophageal and brain tumours
  • After surgery – including convention surgery on the neck, skull base, brain and laser surgery to the throat
  • Radiotherapy to the neck or brain
  • Inflammatory/auto-immune disorders


How to diagnose dysphagia

Diagnosis is usually made on taking a medical history from a patient. Some patients may not be aware of swallowing problems, present with recurrent chest infections, through silently aspirating food and drink.

The severity of the dysphagia is assessed clinically but also through specialist tests such as X-Ray videos of the patient swallowing (videofluoroscopy) and direct observations of the patient swallowing with a trans-nasal flexible camera device (fibreoptic endoscopic evaluation of swallowing).

Dysphagia is usually managed by specialist multidisciplinary teams (MDTs). The aims are to gain sufficient nutrition, protect the airway and allow for the pleasures of taste and social aspects of eating.


Treatment of dysphagia

Management is through an MDT and depends very much on the cause. Where possible, the priority is to treat the underlying medical condition.

The patient could simply be advised to modify the consistency or types of food eaten. There are also exercises for strengthening, such as swallowing muscles and manoeuvres of the head and neck to make each swallow more safely.

Alternative feeding methods such as nasal or directly into the stomach feeding tubes, may be considered for the short or long term in more severe cases.


Surgery for swallowing difficulties

Surgical techniques for helping with the swallow mechanism again depend on the underlying cause, are varied and should only be offered by dysphagia specialists. These may include a tracheostomy to look after the airway, surgery on the muscles of swallowing or on the vocal cords, surgery on a pharyngeal pouch, diverting the airway to a hole in the neck and even removing the larynx.

By Professor Guri Sandhu
Otolaryngology / ENT

Professor Gurpreet (Guri) Sandhu is a world leading surgeon, academic and pioneer in otolaryngology/ENT. He treats the full range of ear, nose, and throat conditions in both adults and children. He has a special interest in voice, airway and swallowing problems, as well as minimally invasive techniques for the management of head and neck tumours.

He has a large private practice across London, managing the problems experienced by professional voice users from stage, music, and media, and is ENT surgeon to the Royal Society of Musicians, and has made outstanding contributions to the field of laryngology. 

Professor Sandhu is Professor of Practice in Laryngology and the lead for the Airway Reconstruction Unit at Imperial College London. This is one of the largest multidisciplinary adult airway services in Europe, achieving National Centre for Airway Reconstruction status. 
He has pioneered minimally invasive approaches to airway diseases that have reduced morbidity and hospital stays for patients.

Professor Sandhu has published over 150 research papers, 15 book chapters and three textbooks. He is committed to education and training, runs several postgraduate courses, and is frequently invited to lecture nationally and internationally.

He is president of the British Laryngological Association and past president for the Royal Society of Medicine section for laryngology and rhinology.

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