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Getting A Grip On Swallowing Problems
By Roya Sayadi, Ph.D., CCC-SLP and Joel Herskowitz, M.D.
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“It hurts when I swallow.”
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“I’m afraid I’m going to choke.”
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“My voice sounds funny after I eat.”
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“I get so tired, I can’t finish a
meal.”
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““What do you expect? I’m old.”
Sometimes, however, a person has no
complaint at all – but a very real problem with
swallowing.
Where Swallowing Breaks Down
To understand how things can go wrong
with swallowing, let’s look briefly at normal
swallowing.
Swallowing is a process – a set of steps
that takes food (or liquid or pills) from mouth to
stomach.
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CHEWING (which, of
course, does not apply to liquids). The tongue,
lips, cheeks, jaw, and teeth work together to reduce
food to a pasty ball. Saliva plays a key role. It
glues together the ground-up food, gathering up
flaky bits so they don’t tickle your throat or get
sucked into your lungs.
When jaw muscles are weak, teeth are missing, or
dentures are loose or painful, chewing will be
impaired. That can set the stage for a choking
emergency.
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TRANSPORTING the food from mouth to
throat. The tongue acts like a bucket without a
handle. Cancer surgery, neurologic disorders (such
as stroke, MS, ALS, or Parkinson’s disease), or
dehydration can interfere with moving the food
along.
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SWALLOWING itself. This is a reflex triggered by
food or liquid getting to where the tonsils are (or
used to be). Several things happen pretty much
at once to make sure food goes into the esophagus,
not into the windpipe.
When muscles are weak (as with muscular dystrophy or
myasthenia gravis) or nerve signals are scrambled or
absent (as with stroke, MS, or ALS), the reflex
cannot provide for safe swallowing.
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THE ESOPHAGUS. Muscles at its beginning and end
act like traffic cops. One-way travel only!
Otherwise, you pay the price with heartburn, bad
breath, or worse.
Connective tissue disorders like scleroderma can
constrict the esophagus and prevent proper movement
of food or liquid. Chronic reflux of acidic stomach
contents (as with GERD) can irritate the lining of
the esophagus and cause it to stick together,
preventing food from getting to the stomach.
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