Swallowing Problems Symptoms and Causes of Trouble Swallowing

Swallowing is a process of moving food and drink from the mouth to the stomach. It is composed of three phases that starts in the throat and extends down to the esophagus. Swallowing is partly voluntary but mainly an involuntary reflex that comprises a well coordinated sequence of events to complete its function. The complexity of this process means that a host of problems can arise, which either affect the swallowing mechanism or lead to a host of symptoms that should otherwise be absent during swallowing.

The two main swallowing problems is difficulty swallowing, known as dysphagia, and pain when swallowing, or odynophagia. The problem may either originate in the oropharynx or esophagus, or less frequently affect the entire alimentary tract from the throat to the esophagus. The mouth is the entry point for the food and drink and a range of disorders at this point may also affect swallowing. However, mouth disorders may not compromise the actual swallowing mechanism.

Swallowing Problems Symptoms

The two problems associated with the swallowing process is difficulty swallowing (dysphagia) and painful swallowing (odynophagia). Pain when swallowing may be due to pain in the mouth, many of the same causes as a sore throat and the various causes of esophagus pain. With painful swallowing, the mechanism of swallowing may not be impaired.

Difficulty Swallowing

Difficulty swallowing may be a result of pathology within the mouth, throat or esophagus. At other times it may stem from diseases processes elsewhere in the body that may affect the swallowing center in the brain, nerves and/or muscles that regulate and enable the swallowing process.

The modalities related to difficulty swallowing includes :

  • Difficulty on empty swallowing
  • Difficulty swallowing pills
  • Difficulty swallowing solid foods
  • Difficulty initiating a swallowing reflex
  • Difficulty maintaining the swallowing reflex
  • Regurgitation after swallowing

Painful Swallowing

Pain when swallowing (odynophagia) is more likely to be related to pathology only within the mouth. A number of modalities of odynophagia may be noticed, including :

  • Pain on dry or empty swallowing
  • Pain when swallowing food
  • Pain when swallowing drinks
  • Pain when swallowing hot food or drinks
  • Pain after swallowing (related to pain due to esophageal swallowing)
  • Painful swallowing in the morning

Other Symptoms

Dysphagia may present with other signs and symptoms like :

  • Regurgitation (into the mouth or nasal cavity)
  • Aspiration (passing up food into the airways)
  • Choking
  • Coughing
  • Discomfort or pain in the back of the mouth, throat (neck), chest
  • Breathing problems
  • Speech or voice problems
  • Weight loss

Causes of Trouble Swallowing

Trouble with swallowing can arise from problems in the mouth, throat (pharynx) or food pipe (eosphagus). Problems in the mouth and first part of the pharynx may result in trouble initiating the swallowing reflex. Disorders of the lower parts of the pharynx and esophagus may result in a problem with completing the entire process of swallowing, which can result in food backing up in the esophagus (dilatation ~ megaesophagus). This is discussed in detail under the types of dysphagia and the various causes are described under oropharyngeal dysphagia and esophageal dysphagia.

Trouble Swallowing and Talking

Any problems with speech may originate from a problem in producing sounds within the larynx (dysphonia) or articulation (dysarthria).

Dysphonia may present a voice hoarseness or a whispering tone to the voice. These causes are discussed further under hoarse voice. The following causes need to be considered :

  • Tumor
  • Stroke
  • Paralysis of the vocal cord (unilateral or bilateral)
  • Foreign body
  • Vagal/laryngeal nerve disorders
  • Muscular conditions like myasthenia gravis

Dysarthria may present as slurred speech. Some of the causes may include :

  • Stroke
  • Muscular conditions like myasthenia gravis
  • Neurodegenerative causes like Parkinson’s disease
  • Facial nerve disorders

Trouble Swallowing and Breathing

Difficulty breathing (dyspnea) may present as shortness of breath, rapid breathing or labored breathing. Some of the causes include :

  • Foreign body
  • Retropharyngeal abscess
  • Tumors of the pharynx
  • Neck masses like a thyroid lymphoma
  • Vocal cord paralysis
  • Anaphylaxis
  • Motor neuron disorders

Other causes of dyspnea are discussed under :

Trouble Swallowing and Sore Throat

It is important to identify whether the soreness or pain in the throat is only present upon swallowing (odynophagia) or persists despite swallowing.

Some of the causes of dysphagia and a sore throat includes :

  • Foreign object in the throat
  • Retropharyngeal abscess
  • Esophageal spasms
  • Esophageal stricture
  • Tumors of the pharynx, larynx or upper esophagus
  • Some of the infections that cause a sore throat (pharyngitis) may also impair swallowing, especially infectious causes of a chronic sore throat