Causes of Difficulty in Swallowing – Oropharyngeal Dysphagia

Causes of Oropharyngeal Dysphagia

Most causes of oropharyngeal dysphagia are neurological or muscular in origin, however, in infants and children it is more likely to be due to an anatomical defect or development abnormalities.

Oropharyngeal dysphagia may also be referred to as high dysphagia. The signs and symptoms of the causes of dysphagia may vary depending on the severity of the condition.

Refer to Dysphagia Symptoms for more specific symptoms of dysphagia itself.

Stroke

This occurs when the blood supply to part of the brain is severely reduced or stopped altogether resulting in ‘oxygen starvation’ of the brain tissue or even cell death.

• Sudden change in walking, talking and vision.
• One sided numbness and/or paralysis.
• Headache with neck stiffness.
• Extreme nausea and vomiting.
• Mental confusion or loss of consciousness.

In a mild stroke, the signs may not always be obvious, especially in a debilitated patient who is bed-ridden.

Motor Neuron Disorders

Progressive destruction of the motor neurons, those nerve cells that carry impulses to initiate and control voluntary movement. This is a group of disorders and not all motor neuron disorders will result in dysphagia.

• Muscle weakness.
• Muscle twitching and cramps.
• Muscle atrophy.

Multiple Sclerosis

Multiple sclerosis is a type of autoimmune disease where the body’s immune system attacks and destroys the insulating layer around nerves. This slows down or blocks nerve impulses.

• Tremor.
• Visual disturbances.
• Numbness and tingling of parts of the body.
• Muscle weakness.
• Dizziness.
• Lack of coordination.

Muscular Dystrophy

This is a group of genetic disorders where there is a gradual and progressive deterioration of the skeletal muscles, which are under voluntary control. The signs and symptoms may vary depending on the type of muscular dystrophy.

• Muscle weakness.
• Lack of coordination.
• Reduced range of motion of limbs in late stages.
• Difficulty breathing (dyspnea) in late stages.

Myasthenia Gravis

Myasthenia gravis is an autoimmune condition where the muscle cell’s ability to respond to the neurotransmitter, acetylcholine, secreted from neurons is impaired due to the destruction of receptor sites. Muscle weakness throughout the body is seen as difficulty with :

• Walking.
• Holding objects.
• Making facial expressions.
• Chewing.
• Swallowing.
• Sight.
• Talking.

Parkinson’s Disease

This conditions develops when there is a lack of the neurotransmitter, dopamine, in the brain.

• Resting tremor
• Slowness of movement.
• Muscle rigidity.
• Impaired balance.
• Stooping posture.

Polio

Also known as poliomyelitis, this is an infectious disease caused by the poliovirus which damages the motor neurons in the spinal cord and brain stem.

• Fever.
• Back and/or neck pain.
• Headache.
• Leg and arm pain.
• Muscle spasms.
• Loss of reflexes.
• Flaccid limbs.

Swelling

Swelling is a sign of inflammation and in severe cases, the normal swallowing action may be impaired. Swelling of the tongue, tonsils, pharynx and epiglottis may be responsible. This may be due to :

• Allergies.
• Infections.
• Toxic substances (ingested or inhaled).
• Trauma.

Tumors

Benign and malignant tumors of the mouth and throat may cause partial, or rarely complete obstruction of the oropharynx. Patients on chemotherapy and those having radiation therapy of the mouth or throat may also experience dysphagia. In terms of a malignancy (cancer), the symptoms will depend on the stage of the condition.

• Swollen lymph nodes.
• Pain at the affected area and upon swallowing.
• Bleeding.